The Role of Late Presenters in HIV-1 Transmission Clusters in Europe

Mafalda N.S. Miranda*, Victor Pimentel, Perpétua Gomes, Maria do Rosário O. Martins, Sofia G. Seabra, Rolf Kaiser, Michael Böhm, Carole Seguin-Devaux, Roger Paredes, Marina Bobkova, Maurizio Zazzi, Francesca Incardona, Marta Pingarilho, Ana B. Abecasis

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review


Background: Investigating the role of late presenters (LPs) in HIV-1 transmission is important, as they can contribute to the onward spread of HIV-1 virus before diagnosis, when they are not aware of their HIV status. Objective: To characterize individuals living with HIV-1 followed up in Europe infected with subtypes A, B, and G and to compare transmission clusters (TC) in LP vs. non-late presenter (NLP) populations. Methods: Information from a convenience sample of 2679 individuals living with HIV-1 was collected from the EuResist Integrated Database between 2008 and 2019. Maximum likelihood (ML) phylogenies were constructed using FastTree. Transmission clusters were identified using Cluster Picker. Statistical analyses were performed using R. Results: 2437 (91.0%) sequences were from subtype B, 168 (6.3%) from subtype A, and 74 (2.8%) from subtype G. The median age was 39 y/o (IQR: 31.0–47.0) and 85.2% of individuals were males. The main transmission route was via homosexual (MSM) contact (60.1%) and 85.0% originated from Western Europe. In total, 54.7% of individuals were classified as LPs and 41.7% of individuals were inside TCs. In subtype A, individuals in TCs were more frequently males and natives with a recent infection. For subtype B, individuals in TCs were more frequently individuals with MSM transmission route and with a recent infection. For subtype G, individuals in TCs were those with a recent infection. When analyzing cluster size, we found that LPs more frequently belonged to small clusters (<8 individuals), particularly dual clusters (2 individuals). Conclusion: LP individuals are more present either outside or in small clusters, indicating a limited role of late presentation to HIV-1 transmission.

Original languageEnglish
Article number2418
Issue number12
Publication statusPublished - 13 Dec 2023


  • HIV-1 infection
  • late presenters
  • non-late presenters
  • transmission clusters


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