Transmission of HIV-1 during primary infection:: relationship to sexual risk and sexually transmitted infections
Transmission of HIV-1 during primary infection:: relationship to sexual risk and sexually transmitted infections
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DOI：
10.1097/00002030-200501030-00010
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发表时间：
2005-01-03
期刊：
影响因子：
3.8
通讯作者：
Pillay, D
中科院分区：
文献类型：
--
作者：
Pao, D;Fisher, M;Pillay, D
目的：为了研究原发性HIV-1感染（PHI），使用分子和流行病学的方法，以评估相关的传播在此population.Methods：个人与PHI前瞻性招募从一个离散的队列1235个人在一个明确的地理区域1999年和2003年之间的后续行动。通过以下方式之一诊断为PHI：18个月内HIV抗体检测阴性，抗体应答不断变化，或应用血清学检测算法进行近期HIV血清转换。对pol基因进行测序以鉴定基因型耐药性并促进分子流行病学分析。临床数据的收集和链接在一个不可挽回的时尚时，知情同意obtained.Results：1999年和2003年之间诊断为PHI的103个人被列入研究，99（96%）是男性和90（91%）是男性与男性发生性关系的人。103个病毒中有35个（34%）出现在15个遗传相关的簇内。与聚集性显著相关的是：年轻、高CD 4细胞计数、性接触次数和诊断前3个月内无保护肛交（UAI）（均P < 0.05）。急性性传播感染（STI）的高发病率在两组中观察到的趋势更高的比率在那些个人与病毒在一个集群（42.9%对27.9%; P = 0.13）。结论：高比率的合作伙伴的变化，UAI和STI的因素，促进在PHI的传播。在公共卫生机构感染期间更积极地识别个人，管理性传播感染和高效抗逆转录病毒疗法都可能是打破传播网络的有用方法。(C)2005年利平科特威廉姆斯威尔金斯。
Objective: To study primary HIV-1 infections (PHI) using molecular and epidemiological approaches in order to assess correlates of transmission in this population.Methods: Individuals with PHI were recruited prospectively from a discrete cohort of 1235 individuals under follow-up in a well-defined geographical area between 1999 and 2003. PHI was diagnosed by one of the following: negative HIV antibody test within 18 months, evolving antibody response, or application of the serological testing algorithm for recent HIV seroconversion. The pol gene was sequenced to identify genotypic resistance and facilitate molecular epidemiological analysis. Clinical data were collected and linked in an irretrievable fashion when informed consent was obtained.Results: A total of 103 individuals with PHI diagnosed between 1999 and 2003 were included in the study; 99 (96%) were male and 90 (91%) were men who have sex with men. Viruses from 35 out of 103 (34%) appeared within 15 phylogenetically related clusters. Significant associations with clustering were: young age high CD4 call count, number of sexual contacts, and unprotected anal intercourse (UAI) in the 3 months before diagnosis (P < 0.05 for all). High rates of acute sexually transmitted infections (STI) were observed in both groups with a trend towards higher rates in those individuals with viruses within a cluster (42.9 versus 27.9%; P = 0.13).Conclusion: High rates of partner change, UAI and STI are factors that facilitate onward transmission during PHI. More active identification of individuals during PHI, the management of STI and highly active anti retroviral therapy may all be useful methods to break transmission networks. (C) 2005 Lippincott Williams Wilkins.