Contribution of transgender sex workers to the complexity of the HIV-1 epidemic in the metropolitan area of Milan

Alessia Lai, Annalisa Bergna, Francesco Roberto Simonetti, Marco Franzetti, Giorgio Bozzi, Valeria Micheli, Chiara Atzori, Annalisa Ridolfo, Gianguglielmo Zehender, Massimo Ciccozzi, Massimo Galli, Claudia Balotta

Research output: Contribution to journalArticlepeer-review


Objectives Transgender people are disproportionately affected by the HIV-1 epidemic. We evaluated the origin of HIV-1 variants carried by South American transgenders living in Milan by combining accurate phylogenetic methods and epidemiological data. Methods We collected 156 HIV-1 pol sequences obtained from transgender patients engaged in sex work (TSWs) followed between 1999 and 2015 at L. Sacco Hospital, Milan, Italy. Phylogenetic analyses were conducted by HIV-TRACE, MrBayes, MacClade and Beast programs. Reference sequences were retrieved from Los Alamos and local databases. Last negative testing or proxy data from clinical records of infected individuals were used to investigate the country of infection. Results Among South American TSWs, the most represented HIV-1 subtypes were B (70.5%), F1 (12.8%) and C (4.4%). Gene flow migrations of B subtype indicated significant fluxes from TSWs to Italians (21.3%) belonging to all risk groups (26.4% to heterosexuals (HEs), 18.9% to men who have sex with men (MSM), 15.1% to injecting drug users). The largest proportion of bidirectional fluxes were observed between Italians and TSWs (24.6%). For F1 subtype, bidirectional viral fluxes involved TSWs and Italians (7.1% and 14.3%), and a similar proportion of fluxes linked TSWs and Italian HEs or MSM (both 15.8%). Significant fluxes were detected from Italians to TSWs for subtype C involving both MSM (30%) and HEs (40%). Country of HIV-1 acquisition was identified for 72 subjects; overall, the largest proportion of patients with B subtype (73.5%) acquired HIV-1 infection in South America. Conclusions Our results indicated that South American transgenders largely contribute to the heterogeneity of HIV-1 variants in our country. The high number of clusters based on all subtypes indicated numerous transmission chains in which TSWs were constantly intermixed with HEs and MSM. Our results strongly advocate interventions to facilitate prevention, diagnosis and HIV-1 care continuum among transgender people.

Original languageEnglish
Pages (from-to)451-456
Number of pages6
JournalSexually Transmitted Infections
Issue number6
Publication statusPublished - Sep 1 2020


  • HIV
  • molecular epidemiology
  • transgender

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases


Dive into the research topics of 'Contribution of transgender sex workers to the complexity of the HIV-1 epidemic in the metropolitan area of Milan'. Together they form a unique fingerprint.

Cite this