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Lei, Quanhong

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Lei

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Quanhong

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Lei, Quanhong

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2013 - 20162

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Author's Publications: search.filters.isAuthorOfPublication.2948c8d7-3b68-44da-bc99-825a94b9b49a

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    Phylogenetic Relatedness of Circulating HIV-1C Variants in Mochudi, Botswana
    (Public Library of Science, 2013) Novitsky, Vladimir; Bussmann, Hermann; Logan, Andrew; Moyo, Sikhulile; van Widenfelt, Erik; Okui, Lillian; Mmalane, Mompati; Baca, Jeannie; Buck, Lauren; Phillips, Eleanor; Tim, David; McLane, Mary; Lei, Quanhong; Wang, Rui; Makhema, Joseph; Lockman, Shahin; DeGruttola, Victor; Essex, M.
    Background: Determining patterns of HIV transmission is increasingly important for the most efficient use of modern prevention interventions. HIV phylogeny can provide a better understanding of the mechanisms underlying HIV transmission networks in communities. Methods: To reconstruct the structure and dynamics of a local HIV/AIDS epidemic, the phylogenetic relatedness of HIV-1 subtype C env sequences obtained from 785 HIV-infected community residents in the northeastern sector of Mochudi, Botswana, during 2010–2013 was estimated. The genotyping coverage was estimated at 44%. Clusters were defined based on relatedness of HIV-1C env sequences and bootstrap support of splits. Results: The overall proportion of clustered HIV-1C env sequences was 19.1% (95% CI 17.5% to 20.8%). The proportion of clustered sequences from Mochudi was significantly higher than the proportion of non-Mochudi sequences that clustered, 27.0% vs. 14.7% (p = 5.8E-12; Fisher exact test). The majority of clustered Mochudi sequences (90.1%; 95% CI 85.1% to 93.6%) were found in the Mochudi-unique clusters. None of the sequences from Mochudi clustered with any of the 1,244 non-Botswana HIV-1C sequences. At least 83 distinct HIV-1C variants, or chains of HIV transmission, in Mochudi were enumerated, and their sequence signatures were reconstructed. Seven of 20 genotyped seroconverters were found in 7 distinct clusters. Conclusions: The study provides essential characteristics of the HIV transmission network in a community in Botswana, suggests the importance of high sampling coverage, and highlights the need for broad HIV genotyping to determine the spread of community-unique and community-mixed viral variants circulating in local epidemics. The proposed methodology of cluster analysis enumerates circulating HIV variants and can work well for surveillance of HIV transmission networks. HIV genotyping at the community level can help to optimize and balance HIV prevention strategies in trials and combined intervention packages.
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    Linear Growth Faltering Among HIV-Exposed Uninfected Children
    (Ovid Technologies (Wolters Kluwer Health), 2016) Sudfeld, CR; Lei, Quanhong; Chinyanga, Y; Tumbare, E; Khan, N; Dapaah-Siakwan, F; Sebaka, A; Sibiya, J; van Widenfelt, E; Shapiro, RL; Makhema, Joseph; Fawzi, Wafaie; Powis, KM
    Background: HIV-exposed uninfected (HEU) children experience increased mortality compared wit their HIV-unexposed uninfected (HUU) peers. It is unclear whether HEU children are also at increased risk for undernutrition, a modifiable risk factor for mortality. Methods: We conducted a cross-sectional, population-based survey of children under 5 years of age in five health districts in Botswana. Linear mixed-effects models were used to assess continuous outcomes while generalized estimating equations were used to estimate relative risks of stunting, wasting, and underweight between HEU (n=396) and HUU (n=1,109) children. Secondary analyses examined potential mediation by low birthweight. Results: The association between maternal HIV-exposure and child stunting varied significantly by child age (p<0.01). HEU children <1 year and ≥2 years of age had 1.85 (95% CI: 1.03-3.31; p=0.04) and 1.41 (95% CI: 1.06-1.88; p=0.02) times the risk of stunting compared with HUU children after multivariate adjustment, respectively. During the period of 1-2 years of age, when breastfeeding cessation occurred among HUU children, HUU children had increased risk of stunting compared with HEU children who were predominantly formula fed (RR: 1.56; 95% CI: 1.05-2.32; p=0.03). A mediation analysis estimated 67% of the excess risk of stunting among HEU children ≥2 years was attributable to low birthweight (p=0.02). There was no difference in risk of wasting or underweight. Conclusion: HEU children are at increased risk of stunting compared with their HUU peers; however, interventions to increase birthweight may significantly ameliorate this excess risk. Interventions to support optimal growth during weaning are needed for all breastfed children.