Objective: To estimate the influence of bursts of rapid HIV transmission on future transmission and describe populations affected by transmission bursts. Design: Phylogenetic analysis of US National HIV Surveillance System data. Methods: Time-scaled phylogenetic trees were inferred for six geographic regions using sequences from persons with HIV (PWH) with diagnoses of HIV infection 2014–2019. Transmission bursts were defined as ≥3 adjacent inferred transmission events in the phylogeny during a detection period. We calculated the relative contribution of transmission bursts 2015–2016 to transmission 2017–2019 compared with non-bursts. Then, we detected bursts within any sliding 2-year period 2014–2019 and assessed descriptive associations of characteristics of individuals involved with or descended from transmission bursts using univariate risk ratios. Results: The 5.6% of phylogenetic lineages involved in transmission bursts 2015–2016 contributed to 14.9% of inferred transmission events 2017–2019. The relative contribution of lineages involved in transmission bursts to future transmission was 2.94 times that of lineages not involved in bursts. Younger age at diagnosis, self-identification as transgender or an additional gender identity, or as a cisgender man, male-to-male sexual contact, injection drug use, or male-to-male sexual contact and injection drug use, and diagnosis during acute or early infection were most strongly associated with involvement in or descendance from transmission bursts. Conclusions: Transmission bursts contribute disproportionately to future HIV transmission, underscoring the value of detecting and responding to rapid transmission to reduce incidence. Bursts of rapid transmission may also contribute to enduring disparities in incidence among some key populations.

Rachael M. Billock

Anne Marie France

Neeraja Saduvala

Nivedha Panneer

Camden J. Hallmark

Joel O. Wertheim

Alexandra M. Oster

AIDS

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​被所有顶级临床医生和研究人员阅读，AIDS 在所有与 AIDS 相关的期刊中影响力最高。 AIDS 每年出版 18 期，保证以权威方式展示重大进展。编辑们本身就是著名的国际专家，他们了解您的工作需求，他们致力于使 AIDS 成为该领域最杰出和最具创新性的期刊。提交的文章将由编辑进行初步审查。有些文章可能会在没有进一步考虑的情况下退回给作者。那些被考虑出版的人将接受编辑的进一步评估和同行评审，以及那些被邀请从审稿人库中这样做的人。

AIDS is the most influential journal among all journals related to AIDS, widely read by top clinicians and researchers. The journal publishes 18 issues annually, aiming to present significant advancements in an authoritative manner. The editorial team consists of internationally recognized experts who understand the needs of researchers and strive to make AIDS the most distinguished and innovative journal in the field. All submitted articles will undergo an initial review by the editors, and some may be returned to authors without further consideration. Articles that are considered for publication will undergo further evaluation by the editors and peer review, conducted by invited reviewers.

《AIDS》是所有与艾滋病相关的期刊中影响力最高的期刊，受到顶级临床医生和研究人员的广泛阅读。该期刊每年出版18期，致力于以权威的方式展示重大进展。编辑团队由国际知名专家组成，他们了解研究者的需求，努力使《AIDS》成为该领域最杰出和最具创新性的期刊。所有提交的文章将经过编辑的初步审查，部分文章可能会在没有进一步考虑的情况下退回给作者。那些被考虑出版的文章将接受编辑的进一步评估和同行评审，评审工作将由邀请的审稿人进行。

Category	Quartile
医学	2
医学, 免疫学	2
医学, 传染病学	2
医学, 病毒学	2

Contribution of HIV transmission bursts to future HIV infections, United States

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