Mode of HIV acquisition among adolescents living with HIV in resource-limited settings: A data-driven approach from South Africa.
Mode of HIV acquisition among adolescents living with HIV in resource-limited settings: A data-driven approach from South Africa.
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DOI：
10.1371/journal.pone.0281298
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
Toska, Elona G.
中科院分区：
文献类型：
--
作者：
He, Eda;Tolmay, Janke;Zhou, Siyanai G.;Saal, Wylene G.;Toska, Elona G.
艾滋病毒携带者(ALHIV)青少年面临独特的治疗和护理挑战，这些挑战可能因他们感染艾滋病毒的方式不同而有所不同，无论是垂直(母乳喂养期间宫内、围产期或出生后接触)还是性(性接触)。区分和记录获得艾滋病毒的模式(MOHA)对于进一步研究ALHIV的不同需求和结果以及根据他们的需求定制艾滋病毒服务至关重要。基于年龄的截止值已被用于确定MOHA的属性，但尚未得到验证。我们分析了南非一项纵向研究的三波队列n=1107名ALHIV患者的数据。基于年龄的MOHA是根据ART开始时的年龄分配的，并根据基于文献假设因素的逻辑树模型进行验证：自我报告的艾滋病毒、性和家族史。在测试了六个ART起始年龄截止点(10至15岁)后，我们通过计算每个截止点的敏感度和特异度来确定最佳的MOHA截止点年龄，并对照最终的逻辑树分配进行衡量。在使用这项纵向研究进行验证之后，方法扩展到另外214名第三波参与者--20岁之前成为母亲的青春期女孩和感染艾滋病毒的年轻妇女。最后，给出了最终拨款的描述性统计数据。在1063名(96.0%)队列研究参与者中，经验证后，68.7%的人垂直感染艾滋病毒。截止年龄10岁前启动ART的敏感性最高(58.9%)，而截止年龄12岁的曲线下面积最大(AUC)(0.712)。在其他感染艾滋病毒的年轻母亲中，95.3%的人估计是通过性行为感染的，遵循同样的算法。在这组人群中，10-12岁截断值的敏感度最高(92.2%)，14岁的AUC最高(0.703)。在10岁之前开始抗逆转录病毒治疗与垂直艾滋病病毒感染密切相关。因此，在流行病学与南非相似的LMIC地区，在研究和临床环境中确定MOHA的截止年龄仍将是建议的10岁。
Adolescents living with HIV (ALHIV) face unique treatment and care challenges which may differ by how they acquired HIV, whether vertically (in-utero, perinatal or postnatal exposure during breastfeeding) or sexually (sexual exposure). Distinguishing and documenting the mode of HIV acquisition (MOHA) is crucial to further research on the different needs and outcomes for ALHIV and to tailor HIV services to their needs. Age-based cut-offs have been used to attribute MOHA but have not been validated. We analysed data from a three-wave cohort of n = 1107 ALHIV part of a longitudinal study in South Africa. Age-based MOHA was allocated using age at ART initiation, validated against a logic-tree model based on literature-hypothesised factors: self-reported HIV, sexual, and family history. After testing six ART initiation age cut-offs (10 to 15 years old), we determined the optimal MOHA cut-off age by calculating the sensitivity and specificity for each cut-off, measured against the final logic-tree allocation. Following validation using this longitudinal study, the methodology is extended to 214 additional third-wave participants—adolescent girls and young women living with HIV who became mothers before the age of 20. Finally, descriptive statistics of the final allocations are presented. Among the 1,063 (96.0%) cohort study participants classified, 68.7% acquired HIV vertically, following validation. ART initiation before cut-off age 10 had the highest sensitivity (58.9%) but cut-off age 12 had the largest area under the curve (AUC) (0.712). Among the additional young mothers living with HIV, 95.3% were estimated to have acquired it sexually, following the same algorithm. For this group, while cut-off ages 10 to 12 had the highest sensitivity (92.2%), age 14 had the highest AUC (0.703). ART initiation before 10 years old is strongly associated with vertical HIV acquisition. Therefore, a cut-off age of 10 would remain the recommendation in LMIC regions with similar epidemiology as South Africa for determining MOHA in research and clinic settings.
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影响因子：
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作者：
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DOI：
10.1097/qai.0000000000002125
发表时间：
2019-10-01
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