Dataset Information

A Population-Structured HIV Epidemic in Israel: Roles of Risk and Ethnicity.

ABSTRACT:

Background

HIV in Israel started with a subtype-B epidemic among men who have sex with men, followed in the 1980s and 1990s by introductions of subtype C from Ethiopia (predominantly acquired by heterosexual transmission) and subtype A from the former Soviet Union (FSU, most often acquired by intravenous drug use). The epidemic matured over the last 15 years without additional large influx of exogenous infections. Between 2005 and 2013 the number of infected men who have sex with men (MSM) increased 2.9-fold, compared to 1.6-fold and 1.3-fold for intravenous drug users (IVDU) and Ethiopian-origin residents. Understanding contemporary spread is essential for effective public health planning.

Methods

We analyzed demographic and virologic data from 1,427 HIV-infected individuals diagnosed with HIV-I during 1998-2012. HIV phylogenies were reconstructed with maximum-likelihood and Bayesian methods.

Results

Subtype-B viruses, but not A or C, demonstrated a striking number of large clusters with common ancestors having posterior probability ?0.95, including some suggesting presence of transmission networks. Transmitted drug resistance was highest in subtype B (13%). MSM represented a frequent risk factor in cross-ethnic transmission, demonstrated by the presence of Israeli-born with non-B virus infections and FSU immigrants with non-A subtypes.

Conclusions

Reconstructed phylogenetic trees demonstrated substantial grouping in subtype B, but not in non-MSM subtype-A or in subtype-C, reflecting differences in transmission dynamics linked to HIV transmission categories. Cross-ethnic spread occurred through multiple independent introductions, with MSM playing a prevalent role in the transmission of the virus. Such data provide a baseline to track epidemic trends and will be useful in informing and quantifying efforts to reduce HIV transmission.

SUBMITTER: Grossman Z

PROVIDER: S-EPMC4547742 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Publications

A Population-Structured HIV Epidemic in Israel: Roles of Risk and Ethnicity.

Grossman Zehava Z Avidor Boaz B Mor Zohar Z Chowers Michal M Levy Itzchak I Shahar Eduardo E Riesenberg Klaris K Sthoeger Zev Z Maayan Shlomo S Shao Wei W Lorber Margalit M Olstein-Pops Karen K Elbirt Daniel D Elinav Hila H Asher Ilan I Averbuch Diana D Istomin Valery V Gottesman Bat Sheva BS Kedem Eynat E Girshengorn Shirley S Kra-Oz Zipi Z Shemer Avni Yonat Y Radian Sade Sara S Turner Dan D Maldarelli Frank F

PloS one 20150824 8

<h4>Background</h4>HIV in Israel started with a subtype-B epidemic among men who have sex with men, followed in the 1980s and 1990s by introductions of subtype C from Ethiopia (predominantly acquired by heterosexual transmission) and subtype A from the former Soviet Union (FSU, most often acquired by intravenous drug use). The epidemic matured over the last 15 years without additional large influx of exogenous infections. Between 2005 and 2013 the number of infected men who have sex with men (MS ...[more]

PMID: 26302493

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Project description:BackgroundSocial inequalities affect the COVID-19 burden and vaccine uptake. The aim of this study was to explore inequalities in the incidence and mortality rate of SARS-CoV-2 infection and vaccine uptake in various sociodemographic and population group strata in Israel.MethodsWe analysed nationwide publicly available, aggregated data on PCR-confirmed SARS-CoV-2 infections and COVID-19 deaths between March 2020 and February 2021, as well as the first three months of COVID-19 immunisation according to sociodemographics, including population group and residential socioeconomic status (SES). We computed incidence and mortality rates of COVID-19. Comparisons between towns with predominantly Arab, ultra-Orthodox Jewish (the minorities), general Jewish populations, and according to SES, were conducted using generalised linear models with negative binomial distribution.FindingsOverall, 774,030 individuals had SARS-CoV-2 infection (cumulative incidence 84•5 per 1,000 persons) and 5687 COVID-19 patients had died (mortality rate 62•8 per 100,000 persons). The highest mortality rate was found amongst the elderly. Most (>75%) individuals aged 60 years or above have been vaccinated with BNT162b2 vaccine. The risk of SARS-CoV-2 infection was higher in towns with predominantly Arab and ultra-Orthodox Jewish populations than in the general Jewish population, and in low SES communities. COVID-19 mortality rate was highest amongst Arabs. Conversely, vaccine uptake was lower amongst Arab and ultra-Orthodox Jewish populations and low SES communities.InterpretationEthnic and religious minorities and low SES communities experience substantial COVID-19 burden, and have lower vaccine uptake, even in a society with universal accessibility to healthcare. Quantifying these inequalities is fundamental towards reducing these gaps, which imposes a designated apportion of resources to adequately control the pandemic.FundingNo external funding was available for this study.

Project description:BackgroundMany studies have shown significant gaps in mortality, and cause specific mortality by educational status. This study investigated these measures in Israel by educational and ethnic status in recent decades.MethodA mortality follow-up till 2017 was done of a cohort of Israeli residents aged 25-64 in 2000 who remained in Israel and had available educational data, grouped into under 8, 9-11, 12, 13-15 and 16 and above years of education. Indirect age adjustment was used to calculate Standard Mortality Ratios (SMRs) by sex and educational group, and a Cox regression model to assess relative risk of total and cause specific mortality controlling for age and ethnic group (Jews and Others and Arabs).The analysis was repeated for each ethnic group separately.Results2,776,422 persons were included of whom 174,792 (6.3%) died till 2017. SMR's for total mortality of males and females with less than 8 years of education compared to 16 and over were 2.2 and 1.8, respectively. Corresponding HR were 2.13 (95% CI 2.08-2.18) and 1.77 (95% CI 1.72-1.82), respectively. The highest cause specific hazard ratios in males were for homicide, 4.40 (95% CI 3.19-6.07), respiratory diseases, 4.01 (95% CI 3.61-4.44), infectious diseases, 3.55 (95% CI 3.15-3.19) and diabetes 3.41 (95% CI 3.06-3.79) and in females for diabetes, 4.41 (95% CI 3.76-5.16), infectious diseases, 4.16 (95% CI 3.52-4.91), respiratory diseases, 4.13 (95% CI 3.55-4.81), and heart disease, 2.96 (95% CI 2.66-3.29). Education-adjusted risk of all-cause mortality for Arab males was 1.07 (1.05-1.09) times that of Jews and Others and non-significant in females. High mortality risk was found for Arab males and females compared to Jews and Others for homicide, diabetes, heart and cerebrovascular disease and for respiratory disease in males. Lower risk was found for suicide and infectious diseases in both sexes and cancer in females.ConclusionWe found significant effect of educational level on all-cause and cause specific mortality, particularly respiratory diseases, infectious diseases, diabetes and homicide. Our results highlight the importance of increasing the educational level of all groups in the population and of encouraging healthy behavior in the lower educated.

Dataset Information

A Population-Structured HIV Epidemic in Israel: Roles of Risk and Ethnicity.

Background

Methods

Results

Conclusions

Publications

A Population-Structured HIV Epidemic in Israel: Roles of Risk and Ethnicity.

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