@article{fdi:010073052,
  title = {{M}assive iatrogenic outbreak of {H}uman {I}mmunodeficiency {V}irus type 1 in rural {C}ambodia, 2014-2015},
  author = {{R}ouet, {F}. and {N}ouhin, {J}. and {Z}heng, {D}. {P}. and {R}oche, {B}enjamin and {B}lack, {A}. and {P}rak, {S}. and {L}eoz, {M}. and {G}audy-{G}raffin, {C}. and {F}erradini, {L}. and {M}om, {C}. and {M}am, {S}. and {G}autier, {C}. and {L}esage, {G}. and {K}en, {S}. and {P}hon, {K}. and {K}erleguer, {A}. and {Y}ang, {C}. {F}. and {K}illam, {W}. and {F}ujita, {M}. and {M}ean, {C}. and {F}ontenille, {D}idier and {B}aring, {F}. and {P}lantier, {J}. {C}. and {B}edford, {T}. and {R}amos, {A}. and {S}aphonn, {V}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground. {I}n 2014-2015, 242 individuals aged 2-89 years were newly diagnosed with human immunodeficiency virus type 1 ({HIV}-1) in {R}oka, a rural commune in {C}ambodia. {A} case-control study attributed the outbreak to unsafe injections. {W}e aimed to reconstruct the likely transmission history of the outbreak. {M}ethods. {W}e assessed in 209 (86.4%) {HIV}-infected cases the presence of hepatitis {C} virus ({HCV}) and hepatitis {B} virus ({HBV}). {W}e identified recent infections using antibody ({A}b) avidity testing for {HIV} and {HCV}. {W}e performed amplification, sequencing, and evolutionary phylogenetic analyses of viral strains. {G}eographical coordinates and parenteral exposure through medical services provided by an unlicensed healthcare practitioner were obtained from 193 cases and 1499 controls during interviews. {R}esults. {C}ases were coinfected with {HCV} (78.5%) and {HBV} (12.9%). {W}e identified 79 (37.8%) recent (< 130 days) {HIV} infections. {P}hylogeny of 202 {HIV} env {C}2{V}3 sequences showed a 198-sample {CRF}01_{AE} strains cluster, with time to most recent common ancestor (t{MRCA}) in {S}eptember 2013 (95% highest posterior density, {A}ugust 2012-{J}uly 2014), and a peak of 15 infections/day in {S}eptember 2014. {T}hree geospatial {HIV} hotspots were discernible in {R}oka and correlated with high exposure to the practitioner ({P}=.04). {F}ifty-nine of 153 (38.6%) tested cases showed recent (< 180 days) {HCV} infections. {N}inety {HCV} {NS}5{B} sequences formed 3 main clades, 1 containing 34 subtypes 1b with t{MRCA} in 2012, and 2 with 51 subtypes 6e and t{MRCA}s in 2002-2003. {C}onclusions. {U}nsafe injections in {C}ambodia most likely led to an explosive iatrogenic spreading of {HIV}, associated with a long-standing and more genetically diverse {HCV} propagation.},
  keywords = {{C}ambodia ; {HBV} ; {HCV} ; {HIV} ; iatrogenic outbreak ; {CAMBODGE}},
  booktitle = {},
  journal = {{C}linical {I}nfectious {D}iseases},
  volume = {66},
  numero = {11},
  pages = {1733--1741},
  ISSN = {1058-4838},
  year = {2018},
  DOI = {10.1093/cid/cix1071},
  URL = {https://www.documentation.ird.fr/hor/fdi:010073052},
}