Deciphering HIV-1 transmission in young adults: Phylogenetic analysis reveals varied histories and an elite
Yael Gozlan1, Joel O Wertheim2, Orna Mor1,3
1Central Virology Laboratory, Ministry of Health, Ramat-Gan, Israel.
Background:
Vertical transmission is the leading mode of HIV-1 acquisition in children and is largely preventable through timely diagnosis and treatment of the mother. However, late diagnosis of HIV-1 in children and young adults highlights systemic failures in prevention and diagnostics. This study aimed to characterize HIV-1 transmission pathways and identify diagnostic gaps through the analysis of mother-child pairs living with HIV-1.
Setting:
The study focused on four mother-child pairs, all of Ethiopian origin, identified in Israel after the children reached young adulthood. All mothers were unaware of their HIV-1 status prior to migration to Israel.
Methods:
A multidisciplinary approach integrating phylogenetic analysis of HIV-1 pol sequences, molecular clock techniques and demographic and clinical data was used to investigate sources and timing of HIV-1 transmission.
Results:
Two children had strains distinct from their mothers' viruses, including one case of a different subtype, suggesting horizontal transmission. Two other children harboured viruses closely related to their mothers', consistent with perinatal vertical transmission. Molecular clock analysis dated the transmission to the year of birth. One young adult exhibited undetectable viral load without treatment, classifying them as an HIV-1 elite controller.
Conclusion:
Although the size of our sample was small, this study demonstrates the challenges in HIV-1 diagnosis in migrant populations. HIV-1 transmission pathways among migrant families show heterogeneity, with gaps in prevention and diagnostics. Targeted policies and improved diagnostic frameworks are essential to address under-diagnosis and late detection, particularly in migrant and priority populations.
