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UK: Whole genome sequencing shows potential as public health tool, but not yet able to definitively prove direction (or timing) in criminal cases

Potential for phylogenetic analysis to show direction of HIV transmission
April 28, 2017

Potential for phylogenetic analysis to show direction of HIV transmission

Tentative results presented in a poster at BHIVA 2017 suggest that a new approach to phylogenetic testing might have the potential to show the direction of HIV infection between two individuals.

While the results are exciting from a scientific perspective, if the approach proves to be robust, this will raise many ethical and legal questions.

Until now, phylogenetic analysis, where sections of two viruses are compared for similarity, has been able to show similarity but crucially not direct infection (a third person could be involved) or direction of infection. Phylogenetic analysis is most useful for showing when transmissions are definitely not linked, when the two strains are unrelated. When linkage is shown, direction of infection cannot be inferred nor the possibility that both infections originated from intermediary partners.

The current study, presented as a poster by Kate El Bouzidi and colleagues from Brighton and Sussex University Hospitals Trust, used whole genome sequencing (WGS) to look at genetic diversity at each of the >9000 individual nucleotide sites in two linked viruses, with heterogeneous samples being interpreted as being the source virus for the sample which had homogeneity at the same nucleotide site.

WGS performed on 170 samples from a UK MSM cohort identified five linked pairs and these were compared to four control pairs where linkage was already established and direction inferred from clinical notes.

The direction of travel was able to be inferred using WGS for 3/4 control pairs, with the single indeterminate result linked to a sample that was taken so long after transmission took place that natural divergence was too great to determine direction.

WGS-inferred direction was consistent with clinical data for 2/5 case pairs. The lack of a signal in two further case pairs with indeterminate was able to be interpreted as not supportive direct transmission, but missing intermediary partners from whom samples were not available.

Finally, the case where WGS-inferred transmission did not match clinical route, was when the sample from the source partner was taken during primary infection (when HIV is likely to be homogenous at most points) several years before likely transmission to the second partner (whose sample was only taken during chronic infection (when heterogeneity is more likely).

This study is funded by both BHIVA and Public Health England as part of the COMPARE-HIV Study (Comparison of Molecular & Phylogenetic Approaches to Reconstruct an Epidemic of HIV), based at Brighton and Sussex University Hospitals NHS Trust.

Comment

The results are preliminary and clearly the timing of samples is likely to be important when interpreting the results from this approach.

WGS may improve our understanding of transmission networks at a population level but it cannot be used to confirm direct transmission at an individual level and sequence data should always be interpreted cautiously in conjunction with clinical information.

However, if the methodology is supported in larger analyses, the results will raise important ethical and legal concerns, especially in countries where HIV transmission is still criminalised.

Reference:

El Bouzidi K et al. Insights into the dynamics of HIV-1 transmission using whole genome deep sequencing. 23rd BHIVA, 4-7 April 2017, Liverpool. Poster abstract P31.

Canada: Man living with HIV in Quebec faces charges of sexual assault for alleged HIV non-disclosure

Un porteur du VIH de nouveau arrêté pour agression sexuelle
April 25, 2017

HIV positive man arrested again  for sexual assault

(Trois-Rivières) After having been sentenced to 81 months in prison for a similar crime in 2011, Michel Lavoie, an HIV-positive man in Trois-Rivières, is again facing a sexual assault charge.

The actions for which this 50-year-old individual is accused allegedly took place on April 14 in his apartment. After the events, the victim went to hospital and filed a complaint with the police. The man who is also known as Michel Ange was quickly arrested and appeared in the Courthouse of Trois-Rivières earlier this week. Because of his criminal record, the Crown opposed his release. He will therefore have to return to court on April 26 for his bail hearing.

Lavoie had regained his liberty in January 2015 after serving his entire sentence. It should be remembered that in 2003 Michel Lavoie had failed to warn his partner at the time that he was HIV positive, although he had known it since 1997. He had also refused to wear the condom suggested by the victim. He had unprotected sex with her on several occasions. In the weeks following the beginning of their romantic relationship, the victim had begun to experience serious health problems, requiring hospitalization. She was eventually diagnosed with an HIV infection. She stayed with him for a few years, being the prisoner of a climate of violence.

During her visit to the hospital, the alleged victim in the new case had to undergo blood sampling to determine if the accused had transmitted HIV to her. The investigators responsible for the case have not yet obtained the results of these tests.

According to Christine Boisvert, communications officer at Sidaction Mauricie, all suspected victims of sexual assault receive treatment called post-exposure prophylaxis. If given between 24 hours and 72 hours after contact with the virus, the chances of success of this treatment are excellent.

“It is a triple therapy given in high doses to stop the virus before it spreads in the system. It must be stopped before it crosses the mucous membranes. Before 72 hours, its success is almost total, “explains Mrs. Boisvert.

Another hope for the alleged victim is that she may not have been infected if Lavoie adequately takes the medication required by his condition and regularly consults his doctor.

“The carriers then fall into an undetectable viral load, that is to say, there are so few viruses by milliliters of blood that it becomes very difficult to transmit,” explained the communication officer.

Published in Le Nouvelliste on April 21, 2017

Un porteur du VIH de nouveau arrêté pour agression sexuelle

(Trois-Rivières) Après avoir été condamné à 81 mois de prison en 2011 pour un crime de même nature, Michel Lavoie, un homme séropositif de Trois-Rivières, fait à nouveau face à une accusation d’agression sexuelle.

Les gestes qui sont reprochés à cet individu de 50 ans auraient été posés le 14 avril dernier dans l’appartement qu’il occupe. Après les événements, la victime s’est rendue à l’hôpital et a porté plainte à la police. Celui qui se fait également appeler Michel Ange a été rapidement arrêté et a comparu au palais de justice de Trois-Rivières en début de semaine. En raison de ses antécédents judiciaires, la Couronne s’est opposée à sa remise en liberté. Il devra donc revenir en cour le 26 avril pour son enquête sur caution.

Lavoie avait recouvré sa liberté en janvier 2015 après avoir purgé la totalité de sa peine. Rappelons qu’en 2003, Michel Lavoie avait omis d’avertir sa partenaire de l’époque qu’il était atteint du VIH, bien qu’il s’en savait atteint depuis 1997. Il avait également refusé le port du condom qui était proposé par la victime. Il avait donc eu des relations sexuelles non protégées avec elle, et ce, à plusieurs reprises. Dans les semaines qui avaient suivi le début de leur relation amoureuse, la victime avait commencé à éprouver de gros problèmes de santé, nécessitant son hospitalisation. On lui avait finalement diagnostiqué une infection au VIH. Elle avait continué à le fréquenter pendant quelques années, étant la prisonnière d’un climat de violence.

Lors de sa visite à l’hôpital, la présumée victime dans cette nouvelle affaire a dû subir des prélèvements sanguins afin de déterminer si l’accusé lui a transmis le VIH. Les enquêteurs responsables du dossier n’ont pas encore obtenu les résultats de ces tests.

Selon Christine Boisvert, agente de communication chez Sidaction Mauricie, toutes les présumées victimes d’agression sexuelle reçoivent un traitement s’appelant la prophylaxie post-exposition. S’il est donné entre 24 heures et 72 heures après le contact avec le virus, les chances de réussite de ce traitement sont excellentes.

«C’est une trithérapie donnée à forte dose afin d’enrayer le virus avant qu’il ne se propage dans le système. Il faut le stopper avant qu’il traverse les muqueuses. Avant 72 heures, sa réussite est presque totale», explique Mme Boisvert.

Autre espoir pour la présumée victime, il se peut qu’elle n’ait pas été infectée si Lavoie prend de façon adéquate la médication requise par sa condition et consulte régulièrement son médecin.

«Les porteurs tombent alors en charge virale indétectable, c’est-à-dire qu’il y a tellement peu de virus de millilitre de sang qu’il devient très difficile à transmettre», poursuit l’agente de communication.

US: HIV criminalisation laws are outdated, stigmatising and applied unfairly and it’s time to end the cycle says Erika D. Smith

The AIDS crisis is over. Why are people still going to jail over HIV?
April 25, 2017

The AIDS crisis is over. Why are people still going to jail over HIV? 

Ireland: Man who spat at police officer during arrest sentenced to 2 months in prison

Stab victim who spat blood in garda’s mouth is jailed for two months
April 25, 2017

Stab victim who spat blood in garda’s mouth is jailed for two months

Defendant pleads guilty to assault and violent disorder following domestic incident

A victim of a stabbing, who spat blood into a garda’s mouth shouting “I have Aids”, has been sentenced to two months in prison.

Paul Goffrock (24) who was stabbed in the leg following an alleged domestic incident, became aggressive to Garda Campbell Brennan.

The court heard that, while Garda Brennan was speaking to him, the defendant, who had blood on his face, spat into the garda’s mouth.

The garda had to receive a course of antibiotics and was unable to work for a week as a result of the incident.

The defendant, of Lambourne Road, Clonsilla, Dublin 15 pleaded guilty to assaulting Garda Brennan at Bremore Pastures Way in Balbriggan and violent disorder at Balbriggan Garda Station on January 10th, 2016.

Garda Colin Fitzpatrick told Swords District Court that gardaí were called to the house following an alleged domestic violence incident.

The defendant had a stab wound to his leg and started shouting abuse towards gardaí after they removed two young children from the house as they felt it was not a safe environment.

‘Tempers were flared’

A sample of the defendant’s blood was taken which proved negative for HIV and hepatitis, the court heard.

After the defendant’s solicitor asked if he would be allowed to engage with the probation services, the judge said he was already given the opportunity but had moved addresses so did not receive his appointment notifications.

“He was someone with a stab wound running amuck,” remarked the judge.

The solicitor said the defendant’s behaviour arose out of a domestic incident and “tempers were flared.”

“There was a break down in the relationship and it went further than it should have. It was a terrible thing for the garda to encounter but the clock can’t be turned back,” the solicitor said.

After the solicitor said the defendant had apologised to Garda Brennan, Garda Fitzpatrick said no apology was ever given.

The judge imposed a two-month sentence for the assault charge and said he won’t consider suspending any part of it.

Canada: Day parole granted to man sentenced to 18 years in prison in 2008 for alleged HIV non-disclosure

Sex Offender Carl Leone Granted Day Parole
April 25, 2017

Sex Offender Carl Leone Granted Day Parole

Convicted sex offender Carl Leone has been granted day parole for up to six months.

The Parole Board of Canada released its decision last Wednesday.

Leone was convicted of 15 counts of sexual aggravated sexual assault after he failed to tell his sexual partners that he was infected with HIV. Over the seven years before his arrest in 2004, at least 22 women were exposed to the virus, and five were infected.

Under Canadian law, anyone who is HIV positive has a legal duty to inform any sexual partners of their status, and Leone is believed to have exposed more women to the virus than anyone else in Canadian history.

A Windsor judge found him guilty in 2008 and sentenced him to 18 years in prison. He was eligible for parole after six years.

A report from the parole board says Leone will stay at a community-based residential facility pending the availability of a bed.

Among the many conditions of his parole, Leone is to avoid all contact with the victims and their families and not to enter the City of Windsor. He can only use the internet for employment purposes and only with the written permission of his parole supervisor, will have to report any relationships with women, sexual and otherwise to his parole supervisor, and not be in the presence of a sex trade worker.

Leone last applied for day parole in September 2016. At that time, he was denied but appealed the decision in January.

The parole board believes he is a low risk to re-offend.

Published in Backburn News on April 24,2017

US: Illinois Court drops charges against man accused of alleged HIV-transmission, taking his suppressed viral load into account

Criminal HIV–transmission charges dropped against suburban man
April 24, 2017

Criminal charges have been dropped against a Wilmette personal trainer who last year was accused of criminal transmission of HIV.

Prosecutors for the Cook County State’s Attorney Office, on April 20, said they would be dropping charges against Jimmy Amutavi, who was last year charged with three counts of criminal HIV-transmission, which is a class-2 felony. Three women accused Amutavi of having condomless sex with them without telling them he was HIV-positive.

But Amutavi has long been on a Treatment as Prevention ( TasP ) medication regimen and his viral-load is suppressed, said Amutavi’s attorney, Jon Erickson.

Studies show that an HIV-positive person with a suppressed viral-load is highly unlikely to transmit HIV. A 2016 study of 1763 HIV-positive individuals, published in New England Journal of Medicine, found no incidences of HIV-transmission once a person become virally-suppressed, for example.

Legal experts and rights-advocates question how and why someone accused of criminal transmission would try to pass the virus along while taking a medication to suppress it. That idea opens a loophole in Illinois law, which says that transmission must be intentional in order for it to be a criminal act, according to Erickson.

“It is clear that my client did everything possible to prevent transmission of HIV by taking anti-retroviral meds, and I am tired and angered that I must continue to defend people who are publicly prosecuted for merely having a manageable disease,” Erickson said. “You simply cannot have the criminal intention to transmit a disease when that disease cannot be transmitted.”

He also said that the prosecutors in the case met with an HIV-specialist at Evanston Hospital in order to get the most up-to-date information before proceeding with Amutavi’s case.

“I congratulate the State’s Attorney’s Office for their open-minded willingness to listen to my arguments and to make the considerable effort to educate themselves on the medically accepted fact that HIV cannot be transmitted when the viral load is suppressed or undetectable,” Erickson added. “Justice was served here.”

Amutavi told Windy City Times, “I’m thankful to my attorney for fighting for me, and to the prosecutors for recognizing that I am innocent. I’m relieved for myself and my family. I’m just looking forward to moving on with my life.”

Published in Windy City Times on April 21, 2017

Zimbabwe: High Court reduces jail sentence of man living with HIV from eight to three years on appeal

HIV+ man’s jail term slashed
April 24, 2017

THE High Court has slashed an eight-year jail term of an HIV positive man who deliberately infected his girlfriend with the deadly virus after engaging in unprotected sex, to three years.

Perfect Ngwenya of Blanket Mine tested HIV positive in June 2014 and was put on antiretroviral therapy. He however, hid the medication from his girlfriend until the woman stumbled on it three months later.

Ngwenya pleaded not guilty to a charge of deliberate transmission of HIV, but was convicted by a Gwanda magistrate and sentenced to eight years in jail.However, three years of the sentence were suspended on condition of good behaviour.

Dissatisfied with the court’s decision, Ngwenya through his lawyers, Shenje and Company, filed an application at the Bulawayo High Court challenging both conviction and sentence.

Justice Nokuthula Moyo, who was sitting with Justice Martin Makonese during the criminal appeals court, confirmed the man’s conviction. She upheld the appeal on sentence and substituted it with an effective two years in jail.

“There is unfortunately no case law on sentencing of offenders in HIV-related offences. The penalty provision is imprisonment for a period not exceeding 20 years as the offence is considered a serious one in nature,” said the judge.

Again the threshold given for a sentence not exceeding 20 years implies as well that the legislature considers that a long term of imprisonment is the appropriate penalty. This is rightly so considering that the deliberate infection of another with HIV changes their whole life in a drastic way and could even affect their life expectancy.”

Justice Moyo said Ngwenya’s personal circumstances warranted the court to interfere with the sentence.“The personal circumstances of the appellant (Ngwenya) are that he is a first offender, and he is on ART as well as that he has hypertension,” she said.The judge said there was no misdirection on the conviction of Ngwenya.

“The conviction is confirmed and the sentence is set aside and substituted with three years in jail of which one year is suspended for five years on condition that the appellant does not within that period commit a similar offence,” ruled the judge.

Ngwenya, in his grounds of appeal, argued that the sentence was excessive and induced a sense of shock. He argued that the magistrate erred in convicting him in the absence of evidence to sustain the charge.

Proven facts of the matter are that Ngwenya tested HIV positive on June 26 in 2014. The affair between him and the complainant had started in August 2013. The two engaged in unprotected sex on several occasions until the complainant stumbled on Ngwenya’s antiretroviral drugs on September 4 in 2014. Ngwenya had not revealed his HIV status to his girlfriend. The court heard that the complainant had tested twice in 2012 prior to her relationship with Ngwenya and the results came out negative. A report was made leading to Ngwenya’s arrest.

Paraguay: Criminal complaint filed against man living with HIV for alleged HIV transmission

Denuncian a abogado que habría transmitido VIH a 13 mujeres
April 19, 2017

Lawyer accused of having transmitted HIV to 13 women (Google translation. For article in Spanish, please scroll down)

Two women filed a criminal complaint against a lawyer who has intentionally transmitted HIV to them. Another 11 women are said to be in the same situation, but for different reasons did not dare reporting it.

The two women who filed the criminal complaint claim to have contracted the disease after a relationship with the lawyer. They accuse him of transmitting the virus intentionally, so reported him to the Public Ministry.

In total there would be about 13 victims, all ex-partners of the man, who forced them not to use contraceptive methods and asked them to have children. In all, the man would have had about 9 children with his alleged victims.

Attorney Mirna Morínigo said that a formal complaint was filed previously against the man, but the victim was forced to withdraw the complaint in the face of constant threats.

The case is in the hands of the Prosecutor’s Office who must investigate if there was an intention on the part of the man, who could be prosecuted for causing serious harm, with an expectation of up to 10 years in prison.

Published in Paraguay.com, on April 19, 2017

——————————————————————-

Denuncian a abogado que habría transmitido VIH a 13 mujeres

VIDEO. Dos mujeres radicaron una denuncia penal contra un abogado que les habría transmitido VIH intencionalmente. Otras 11 mujeres estarían en la misma situación, pero por distintas causas no se animan a denunciarlo.

Las dos mujeres que radicaron la denuncia penal aseguran haber contraído la enfermedad tras una relación con el abogado. Lo acusan de haberles transmitido el virus de forma intencional, por lo que lo denunciaron ante el Ministerio Público.

En total serían unas 13 las víctimas, todas ex parejas del hombre, quien las obligaba a no utilizar métodos anticonceptivos y les pedía tener hijos. En total, el hombre habría tenido unos 9 hijos con sus supuestas víctimas.

La abogada Mirna Morínigo señaló que anteriormente se radicó una denuncia formal contra el hombre, pero la víctima se vio obligada a retirar la demanda ante las constantes amenazas.

El caso está en manos de la Fiscalía que debe investigar si existió intención por parte del hombre, quien podría ser procesado por lesión grave, con una expectativa de pena de hasta 10 años de cárcel.

 

US: Fact sheet from the Williams Institute summarises all we know about HIV criminalisation in California

HIV Criminalization: What We Know, The Williams Institute, UCLA School of Law (2017)
April 17, 2017

This fact sheet from The Williams Institute highlights significant findings from its research on HIV criminal laws in California. Conduct criminalized includes condomless anal or vaginal sex with intent to transmit HIV and without HIV status disclosure, as well as donation of blood, tissue, semen, or breast milk for people living with HIV (PLHIV) who know their HIV status. It also enhances the criminal penalty for PLHIV convicted of solicitation and for sexual assault crimes.

Particularly notable findings include that:
• 98% of convictions required no proof of intent to transmit HIV;
• 93% of convictions required no proof of conduct that is likely to transmit HIV;
• HIV criminal statutes disproportionately affect women, people of color, and immigrants living with HIV, and they are disparately enforced based on race/ethnicity and gender; and
• felony solicitation enforcement has disproportionate impact on LGBTQ youth and transgender women of color.

HIV Criminalization in CA- What We Know.pdf

 

Germany: Cologne court acquits man with undetectable viral load of attempted grievous bodily harm; judge learns about treatment as prevention from expert witness

Freispruch für Kölner HIV–Infizierter (41) hatte ungeschützten Sex mit Kolleginnen
April 15, 2017

English version via Google translate from Express.de (Original German text is below)

Acquittal for Cologne man: HIV-positive man (41) had unprotected sex with colleagues
By Hendrik Pusch, Express.de, 12 April 2017

Cologne – Markus S. (41, name changed) is infected with the immune virus HIV. But that did not prevent him from having unprotected sex. Because he did not disclose to two women his illness, the man had to face the court on Wednesday before the magistrate. But the process took a surprising turnaround.

Prosecution: attempted bodily injury

For the Cologne prosecutor’s office, the case was clear. They accused the welfare beneficiary of attempted grievous bodily harm. Attempted, because the sex partners – two colleagues at work – had not acquired HIV. For many weeks they had lived with the fear of being infected.

The accused could also prove by his treating physician that he had not been contagious at the time of sexual intercourse. By taking inhibitory drugs, the virus in the blood could not be detected any more.

Virus not contagious

The HIV disease of the accused could only be proven in the hereditary material, a senior physician of the university clinic, who had been invited as an expert and had been dealing with HIV and AIDS for more than 30 years.

“Effective HIV therapy can even provide better protection than a condom,” the doctor said. Provided of course, the patient regularly takes his medication.

Acquittal in court

“I’ve learned a lot about medical research in this procedure,” said Judge Dr. Frank Altpeter. The judge found that the defendant was a “model patient”.

Since S. was not contagious, he did not have to report the infection to the ladies before sex. Acquittal!


 

Freispruch für Kölner HIV-Infizierter (41) hatte ungeschützten Sex mit Kolleginnen

Von Hendrik Pusch, Express.de, 12.04.17

Köln – An Drogenbesteck hat sich Markus S. (41, Name geändert) mit dem Immun-Virus HIV infiziert. Das hielt ihn aber nicht davon ab, ungeschützten Sex zu haben. Weil er zwei Frauen seine Krankheit verschwieg, musste sich der Mann am Mittwoch vor dem Amtsgericht verantworten. Doch der Prozess nahm eine überraschende Wende.

Anklage: versuchte Körperverletzung

Für die Kölner Staatsanwaltschaft war der Fall klar. Sie klagte den Sozialhilfeempfänger wegen versuchter gefährlicher Körperverletzung an. Versucht, weil sich die Sex-Partnerinnen – zwei Kolleginnen in einer Arbeitsmaßnahme – nicht mit dem HI-Virus angesteckt hatten. Viele Wochen hatten sie mit der Angst gelebt, doch infiziert zu sein.

Der Erkrankte konnte  durch seinen behandelnden Arzt auch nachweisen, zum Zeitpunkt des Geschlechtsverkehrs gar nicht ansteckend gewesen zu sein. Durch die Einnahme von hemmenden Medikamenten konnte der Virus im Blut tatsächlich nicht mehr nachgewiesen werden.

Virus nicht ansteckend

Lediglich im Erbgut konnte die HIV-Erkrankung des Angeklagten nachgewiesen werden, bestätigte auch ein Oberarzt der Uniklinik, der als Gutachter geladen war und sich seit mehr als 30 Jahren mit HIV und Aids beschäftigt.

 „Eine wirksame HIV-Therapie kann sogar einen besseren Schutz als ein Kondom darstellen“, sagte der Mediziner.  Vorausgesetzt natürlich, der Patient nehme regelmäßig seine Medikamente.

Freispruch vor Gericht

„Ich habe in diesem Verfahren viel über die medizinische Forschung gelernt“, sagte der Richter Dr. Frank Altpeter.  Der Richter stellte fest, dass es sich beim Angeklagten um einen „Muster-Patienten“ handelte.

Da S. nicht ansteckend war, habe er den Damen vorm Sex auch nicht von der Infizierung berichten müssen. Freispruch!

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