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)
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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
*
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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
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Acknowledgments
HIV Berodung