Recent HIV outbreak in people who inject

cocaine in Luxembourg: identification of 2

transmission clusters

Carole Devaux , PhD

HIV-Clinical and Translational Research Unit

Department of Infection and immunity

1

2

HIV infection in Luxembourg

A total of 1316 patients infected with HIV followed at the National Service of Infectious Diseases

544 000 inhabitants

2 586 km²

3

Demographic characteristics of the Lux cohort

25%

15%

10%

Sub-Saharan Africa

Western Europe

4

HIV epidemiology : a majority of non-B subtypes

Increased frequency of recombinants (CRF42)

Struck D et al, AIDS Res Hum Retroviruses 2015

Luxembourg is a migratory target and

imports viral diversity from abroad

Paraskevis D, Retrovirology 2009

Luxembourg-Ghent-Antwerp :

30% of non-B infections occurred now in native

Western European population

Dauwe K et al, BMC Infectious Diseases 2015

5

Evolution of contamination mode

IVDU

Homo/bisexual

2013-2016:

51 cases

(5 new IVDU

cases in April

2016)

Heterosexual

6

Number of new/old infections (in care 3 months after first seropositivity)

IVDUMSM

IVDU: 4 patients with acute infection between 2013-2016

TROD available, DIMPS project (HIV Berodung)

Opening of 2 new free of charge HIV testing sites since 2014

Legislation for HIV self-testing and PrEP ongoing (National HIV plan 2016-

2021)

7

Phylogenetic tree of the Lux Cohort

Confirmed by large scale analysis

1015 Lux sequences

40 826 LANL + 170 subtype reference sequences LANL

1015 Lux sequences

158 subtype sequences LANL

Definition of clusters: > 6 patients

2013-2016: 46/51 virus genotyped:1 main B IVDU cluster of 34 patients

24 cases in 2013-2016 /34 cases, genotype B, within sequences from Italy and Spain

8 * Bootstrap values P > 0.85

*

9 4 cases belong to 4 other clusters (2 MSM, 1 heterosexual, 1 CFR42)

2013-2016: 46/51 virus genotyped:1 G/CRF-14BG IVDU cluster of 12 patients

8 cases in 2013-

2016 /12 cases,

genotype G/CRF-

14BG, within

sequences from

Portugal and

Spain

* Bootstrap values P > 0.80

*

10

Epidemiological and clinical data

n = 7

n = 21

All cases have reported cocaine injection in addition of heroine injection

Median

age (IQR)Sexe

Birth

country

Median inclusion

viral load (IQR)

cp/ml

Median

CD4 (IQR)

cells/µl

HCV

Infection

HCV

genotype

32 Male : 17 Lux : 17 15 957 737 Past : 8 1a : 6

(28-37) Female: 5 OC : 5 (3 091- 30 287) (491 - 959) Ongoing : 12 3a : 9

36 Male : 6 Lux : 3 52 168 515 Past : 3 1a : 5

(28 - 42) Female: 1 OC : 4 (16 824 - 226 531) (263 - 616) Ongoing : 4

Cluster HIV B

Cluster HIV G

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Increased injection cocaine use since 2012

YEAR RELIS recorded drug users Supervised drug consumption rooms Primary drug Secondary drug Total

Cocaine IDU

Cocaine non-IDU

Cocaine IDU

Cocaine non-IDU

Cocaine Cocaine Cocaine mixtures

Cocaine total

2012 4 9 18 22 53 3 2 5 2013 6 11 13 21 51 4 3 7 2014 6 14 22 19 61 6 5 11 2015 8 11 20 24 63 11 9 20

- Since 2014, HIV/HCV prevention programs reinforced

- Discourage injections, additional smoking rooms

- Another facility for drug consumption in the south of the country

- Outreach project, MOPUD, to reach marginalised drug users

(injectors) with poor or no contact with care offers.

- Operational research: HCV-UD, prevention of reinfection in prison

and at discharge

Relis report 2016, A Origer

Dr Alain Origer, National drug coordinator, Ministry of Health

Dr Vic Arendt, Service National des Maladies infectieuses, Centre Hospitalier de Luxembourg

HIV Berodung: Natacha da Silva, Laurence Mortier

CHL: Dr Jean-Hugues François, Henry Goedertz, Karin Hawotte

LIH: Laurence Guillorit, Aurélie Fischer, Christine Lambert, Cécile Masquelier, Morgane Lemaire, Valérie Etienne, Jean-Yves Servais, Gilles Iserentant

Fondation Recherche sur le SIDA, Dr Robert Hemmer

12

Acknowledgments

HIV Berodung