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Limited cross-border infections in patients newly diagnosed with HIV in Europe

Dineke Frentz1, Annemarie M J Wensing2, Jan Albert34, Dimitrios Paraskevis5, Ana B Abecasis6, Osamah Hamouda7, Louise B Jørgensen8, Claudia Kücherer7, Daniel Struck9, Jean-Claude Schmit109, Birgitta Åsjö11, Claudia Balotta12, Danail Beshkov13, Ricardo J Camacho146, Bonaventura Clotet15, Suzie Coughlan16, Stéphane De Wit17, Algirdas Griskevicius18, Zehava Grossman19, Andrzej Horban20, Tatjana Kolupajeva21, Klaus Korn22, Leondios G Kostrikis23, Kirsi Liitsola24, Marek Linka25, Claus Nielsen8, Dan Otelea26, Roger Paredes16, Mario Poljak27, Elisabeth Puchhammer-Stöckl28, Anders Sönnerborg294, Danica Stanekova30, Maja Stanojevic31, Anne-Mieke Vandamme326, Charles A B Boucher1, David A M C Van de Vijver1* and SPREAD Programme

Author Affiliations

1 Department of Virology, Erasmus Medical Center, Rotterdam, The Netherlands

2 Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands

3 Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden

4 Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden

5 National Retrovirus Reference Center, Department of Hygiene Epidemiology of Medical Statistics, Medical School, University of Athens, Athens, Greece

6 Centro de Malária e outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal

7 Robert Koch-Institute, Berlin, Germany

8 Statens Serum Institute, Copenhagen, Denmark

9 Laboratory of Retrovirology, CRP-Santé, Luxembourg, Luxembourg

10 Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg

11 Section for Microbiology and Immunology,The Gade Institute, University of Bergen, Bergen, Norway

12 University of Milan, Milan, Italy

13 Department of Virology, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria

14 Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal

15 irsiCaixa AIDS Research Institute & Lluita contra la SIDA Foundation, Hospital Universitari ”Germans Trias i Pujol”, Badalona, Spain

16 University College Dublin, Dublin, Ireland

17 Department of Infectious Diseases, St Pierre University Hospital, Brussels, Belgium

18 National Public Health Surveillance Laboratory, Vilnius, Lithuania

19 School of Public Health, Tel-Aviv University, Tel Aviv, Israel

20 Warsaw Medical University and Hospital of Infectious Diseases, Warsaw, Poland

21 Infectology Center of Latvia, Riga, Latvia

22 University of Erlangen-Nuremberg, Erlangen, Germany

23 University of Cyprus, Nicosia, Cyprus

24 National Institute for Health and Welfare, Helsinki, Finland

25 National Institute of Public Health, Prague, Czech Republic

26 Molecular Diagnostics, ”Prof. Dr. Matei Bals“ Institute for Infectious Diseases, Bucharest, Romania

27 University of Ljubljana, Ljubljana, Slovenia

28 Medical University Vienna, Vienna, Austria

29 Divisions of Infectious Diseases and Clinical Virology, Karolinska Institute, Stockholm, Sweden

30 Slovak Medical University, Bratislava, Slovakia

31 School of Medicine, University of Belgrade, Belgrade, Serbia

32 Rega Institute for Medical Research, KU Leuven, Leuven, Belgium

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Retrovirology 2013, 10:36  doi:10.1186/1742-4690-10-36

Published: 3 April 2013



International travel plays a role in the spread of HIV-1 across Europe. It is, however, not known whether international travel is more important for spread of the epidemic as compared to endogenous infections within single countries. In this study, phylogenetic associations among HIV of newly diagnosed patients were determined across Europe.


Data came from the SPREAD programme which collects samples of newly diagnosed patients that are representative for national HIV epidemics. 4260 pol sequences from 25 European countries and Israel collected in 2002–2007 were included.

We identified 457 clusters including 1330 persons (31.2% of all patients). The cluster size ranged between 2 and 28. A number of 987 patients (74.2%) were part of a cluster that consisted only of patients originating from the same country. In addition, 135 patients (10.2%) were in a cluster including only individuals from neighboring countries. Finally, 208 patients (15.6%) clustered with individuals from countries without a common border. Clustering with patients from the same country was less prevalent in patients being infected with B subtype (P-value <0.0001), in men who have sex with men (P-value <0.0001), and in recently infected patients (P-value =0.045).


Our findings indicate that the transmission of HIV-1 in Europe is predominantly occurring between patients from the same country. This could have implications for HIV-1 transmission prevention programmes. Because infections through travelling between countries is not frequently observed it is important to have good surveillance of the national HIV-1 epidemics.

Europe; HIV-1; Transmission; Clusters