Human Immunodeficiency Virus (HIV)-1 Transmission among Persons with Acute HIV-1 Infection in Malawi: Demographic, Behavioral, and Phylogenetic Relationships

Ann M. Dennis, Myron S. Cohen, Katherine B. Rucinski, Sarah E. Rutstein, Kimberly A. Powers, Dana K. Pasquale, Sam Phiri, Mina C. Hosseinipour, Gift Kamanga, Dominic Nsona, Cecilia Massa, Irving F. Hoffman, Audrey E. Pettifor, William C. Miller

Research output: Contribution to journalArticlepeer-review


Background: Understanding sexual networks involving acute human immunodeficiency virus (HIV)-1 infections (AHI) may lead to prevention opportunities to mitigate high rates of onward transmission. We evaluated HIV-1 phylogenetic and behavioral characteristics among persons with AHI and their referred partners. Methods: Between 2012 and 2014, 46 persons with AHI in Malawi participated in a combined behavioral and biomedical intervention. Participants referred sexual partners by passive referral. Demographics and sexual behaviors were collected through interviews and HIV-1 genetic relationships were assessed with phylogenetics. Results: Among 45 AHI participants with HIV-1 sequences, none was phylogenetically-linked with another AHI index. There were 19 (42%) AHI participants who referred a single partner that returned for testing. Most partners (n = 17) were HIV-infected, with 15 (88%) presenting with an established infection. There were 14 index-partner pairs that had sequences available; 13 (93%) pairs were phylogenetically-linked dyads. The AHI index was female in 7/13 (54%) dyads. Age-disparate relationships among dyads were common (≥5-year age difference in 67% of dyads), including 3/6 dyads involving a male index and a younger woman. Index participants with a referred partner were more likely to report no casual partners and to be living with their current partner than participants not in dyads. Conclusions: Passive-partner referral successfully identified partners with genetically-similar HIV infections - the likely source of infection - but only 40% of index cases referred partners who presented for HIV-1 testing. Future work evaluating assisted partner notification may help reach susceptible partners or more people with untreated HIV-1 infections connected to acute transmission. Clinical Trials Registration: NCT01450189.

Original languageEnglish (US)
Article numberciy1006
Pages (from-to)853-860
Number of pages8
JournalClinical Infectious Diseases
Issue number5
StatePublished - Aug 16 2019


  • HIV-1
  • Malawi
  • molecular epidemiology
  • partner notification
  • phylogeny: transmission

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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