![]() ![]() ![]() In addition, reconstructing transmission patterns from HIV-1 sequences comes with its own ethical challenges because HIV-1 transmission is criminalized in many countries ( Dawson et al., 2020). The accuracy of these estimates, however, is impeded by the unknown number of people with undiagnosed infections, or with diagnosed infections that have not been sequenced ( Didelot et al., 2017). Furthermore, the spread of infections from one place to another can be extrapolated by reconstructing locations of ‘ancestral’ infections at deeper nodes of the tree from the known locations at the tips ( Faria et al., 2011). These genetic sequences can be used to build a tree that represents the shared evolutionary history of the infections and approximates the history of recent transmissions ( De Maio et al., 2018 Romero-Severson et al., 2014). This is especially true for HIV-1, a rapidly evolving virus that becomes genetically unique within months of an infection ( Williamson, 2003). Infections that are genetically similar are more likely to be related through recent transmissions. However, contact tracing is both time-consuming and intrusive ( El-Sadr et al., 2022).Ī cost-effective alternative to contact tracing is to compare the genomic sequences of HIV-1 samples from different patients, which are often collected to screen for mutations that confer drug resistance. This means reconstructing the spread of HIV-1 between individuals through contact tracing: interviewing people recently diagnosed with HIV, and locating and notifying their intimate partners. In cities that have scaled up HIV-1 treatment and prevention, it will be crucial to establish whether new HIV-1 infections are due to ongoing local transmission or to infections acquired abroad. This requires significant investment in resources to treat and prevent the disease, such as reducing the number of people who do not know they are carrying the virus and improving the availability and affordability of effective treatments. Global health sector strategies strive to end HIV-1 epidemics by 2030 ( Duncombe et al., 2019). The human immunodeficiency virus type 1 (HIV-1), which can lead to acquired immune deficiency syndrome (AIDS), remains a leading cause of death and a health threat worldwide, with over 38.4 million people currently living with the virus. ![]()
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