Sources of HIV infection among men having sex with men and implications for prevention.
Sources of HIV infection among men having sex with men and implications for prevention.
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DOI：
10.1126/scitranslmed.aad1863
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发表时间：
2016-01-06
影响因子：
17.1
通讯作者：
ATHENA observational cohort
中科院分区：
文献类型：
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作者：
Ratmann O;van Sighem A;Bezemer D;Gavryushkina A;Jurriaans S;Wensing A;de Wolf F;Reiss P;Fraser C;ATHENA observational cohort
在大多数国家，尽管护理和预防服务在过去二十年大幅扩大，但男男性行为者 (MSM) 的艾滋病毒新诊断人数并未明显减少。为了最大限度地发挥预防策略的影响，量化人口层面的传播源至关重要。我们使用欧洲一项全国性队列研究的病毒序列和临床患者数据来估计 617 名最近感染的 MSM 的可能传播来源。 71% 的传播来自未确诊的男性，6% 来自已开始抗逆转录病毒治疗 (ART) 的男性，1% 来自至少 18 个月没有接触过护理的男性，43% 来自感染第一年的男性。荷兰男男性行为者的发病率没有大幅下降并不是因为抗逆转录病毒治疗无效或护理保留不足造成的。在反事实建模场景中，通过当前的年度检测覆盖率和对检测呈阳性的人立即进行抗逆转录病毒疗法，19% 的过去病例本可以避免。其中 66% 的病例可以通过可用的抗逆转录病毒药物来避免（向所有检测呈阳性的 MSM 立即提供 ART，并为所有 HIV 检测呈阴性的一半患者进行暴露前抗逆转录病毒预防），但前提是所有有传播风险的男性中的一半每年进行检测。随着序列覆盖率的增加，分子流行病学分析可以成为将艾滋病毒预防策略指导到主要感染源的关键工具，并帮助男男性接触者中的艾滋病毒流行率得到决定性下降。
New HIV diagnoses among men having sex with men (MSM) have not decreased appreciably in most countries, even though care and prevention services have been scaled up substantially in the past twenty years. To maximize the impact of prevention strategies, it is crucial to quantify the sources of transmission at the population level. We used viral sequence and clinical patient data from one of Europe’s nation-wide cohort studies to estimate probable sources of transmission for 617 recently infected MSM. 71% of transmissions were from undiagnosed men, 6% from men who had initiated antiretroviral therapy (ART), 1% from men with no contact to care for at least 18 months, and 43% from those in their first year of infection. The lack of substantial reductions in incidence amongst Dutch MSM is not a result of ineffective ART provision or inadequate retention in care. In counterfactual modeling scenarios, 19% of these past cases could have been averted with current annual testing coverage and immediate ART to those testing positive. 66% of these cases could have been averted with available antiretrovirals (immediate ART provided to all MSM testing positive, and pre-exposure antiretroviral prophylaxis taken by half of all who test negative for HIV), but only if half of all men at risk of transmission had tested annually. With increasing sequence coverage, molecular epidemiological analyses can be a key tool to direct HIV prevention strategies to the predominant sources of infection, and help send HIV epidemics amongst MSM into a decisive decline.