Large age shifts in HIV-1 incidence patterns in KwaZulu-Natal, South Africa.
Large age shifts in HIV-1 incidence patterns in KwaZulu-Natal, South Africa.
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DOI：
10.1073/pnas.2013164118
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发表时间：
2021-07-13
影响因子：
11.1
通讯作者：
Tanser F
中科院分区：
文献类型：
--
作者：
Akullian A;Vandormael A;Miller JC;Bershteyn A;Wenger E;Cuadros D;Gareta D;Bärnighausen T;Herbst K;Tanser F
由于预防和阻断传播治疗的规模扩大，在撒哈拉以南非洲一些最严重的流行病中，艾滋病毒发病率最近有所下降。了解发病率的下降是否在不同年龄和性别之间同样存在，有助于优先考虑需要更多努力降低传播的人口群体。我们发现，在世界上艾滋病毒流行率最高的人口中，最年轻的男性和女性的艾滋病毒发病率下降得不成比例。风险年龄分布的变化可能是老龄化流行、优先预防年轻人以及感染年龄因总体感染力降低而延迟的结果。我们的研究结果强调了扩大艾滋病毒预防年龄目标的必要性。在撒哈拉以南非洲高负担社区大规模推广抗逆转录病毒疗法和艾滋病毒初级预防之后，成人艾滋病毒1型感染率最近有所下降。数学模型表明，随着干预措施的规模扩大，艾滋病毒风险将在年轻成年人中不成比例地下降，随着时间的推移，新的艾滋病毒感染集中在25岁以上的人群中。然而，没有经验数据支持这些预测。我们进行了一项为期16年（2004年至2019年）的基于人群的队列研究，涵盖抗逆转录病毒治疗和自愿医疗男性包皮环切术的早期规模扩大，以估计南非夸祖鲁-纳塔尔高流行地区HIV发病率年龄分布的变化，该地区成人HIV发病率最近有所下降。HIV血清转换的中位年龄男性增加了5.5岁，女性增加了3.0岁，HIV发病高峰年龄男性增加了5.0岁，女性增加了2.0岁。年轻男子的发病率下降不成比例（15至19岁男性占64%，20至24岁男性占68%，25至29岁男性占46%）和年轻女性（15至19岁女性中为44%，在20 - 24岁的女性中为24%），比较普遍检测和治疗前后的时期。（<20%的变化）在30至39岁的女性和30至34岁的男性。发病率的年龄变化发生在2012年之后，男性比女性早。这些结果提供了直接的流行病学证据，表明在大规模治疗和预防的时代，撒哈拉以南非洲艾滋病毒风险的人口统计数据正在发生变化。需要更多地关注老年人发病率下降滞后的问题。
HIV incidence has recently been in decline across some of the most intense epidemics in sub-Saharan Africa due to the scale-up of prevention and transmission-blocking treatments. Understanding whether declines in incidence are being felt equally across age and gender can help prioritize demographic groups where more effort is needed to lower transmission. We found that HIV incidence has declined disproportionately in the youngest men and women in a population with the highest HIV prevalence in the world. Shifts in the age distribution of risk may be the consequence of aging prevalence, prioritized prevention to younger individuals, and delays in age at infection from reduced overall force of infection. Our results highlight the need to expand age targets for HIV prevention. Recent declines in adult HIV-1 incidence have followed the large-scale expansion of antiretroviral therapy and primary HIV prevention across high-burden communities of sub-Saharan Africa. Mathematical modeling suggests that HIV risk will decline disproportionately in younger adult age-groups as interventions scale, concentrating new HIV infections in those >age 25 over time. Yet, no empirical data exist to support these projections. We conducted a population-based cohort study over a 16-y period (2004 to 2019), spanning the early scale-up of antiretroviral therapy and voluntary medical male circumcision, to estimate changes in the age distribution of HIV incidence in a hyperepidemic region of KwaZulu-Natal, South Africa, where adult HIV incidence has recently declined. Median age of HIV seroconversion increased by 5.5 y in men and 3.0 y in women, and the age of peak HIV incidence increased by 5.0 y in men and 2.0 y in women. Incidence declined disproportionately among young men (64% in men 15 to 19, 68% in men 20 to 24, and 46% in men 25 to 29) and young women (44% in women 15 to 19, 24% in women 20 to 24) comparing periods pre- versus post-universal test and treat. Incidence was stable (<20% change) in women aged 30 to 39 and men aged 30 to 34. Age shifts in incidence occurred after 2012 and were observed earlier in men than in women. These results provide direct epidemiological evidence of the changing demographics of HIV risk in sub-Saharan Africa in the era of large-scale treatment and prevention. More attention is needed to address lagging incidence decline among older individuals.
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影响因子：
16
作者：
Gross AM;Jaeger PA;Kreisberg JF;Licon K;Jepsen KL;Khosroheidari M;Morsey BM;Swindells S;Shen H;Ng CT;Flagg K;Chen D;Zhang K;Fox HS;Ideker T
通讯作者：
Ideker T
影响因子：
3.8
作者：
Barnighausen, Till;Tanser, Frank;Newell, Marie-Louise
通讯作者：
Newell, Marie-Louise
DOI：
10.1056/nejmoa1702150
发表时间：
2017-11-30
期刊：
The New England journal of medicine
影响因子：
--
作者：
Grabowski MK;Serwadda DM;Gray RH;Nakigozi G;Kigozi G;Kagaayi J;Ssekubugu R;Nalugoda F;Lessler J;Lutalo T;Galiwango RM;Makumbi F;Kong X;Kabatesi D;Alamo ST;Wiersma S;Sewankambo NK;Tobian AAR;Laeyendecker O;Quinn TC;Reynolds SJ;Wawer MJ;Chang LW;Rakai Health Sciences Program
通讯作者：
Rakai Health Sciences Program
DOI：
10.1097/qad.0000000000001553
发表时间：
2017-07-31
期刊：
AIDS (London, England)
影响因子：
--
作者：
Akullian A;Bershteyn A;Klein D;Vandormael A;Bärnighausen T;Tanser F
通讯作者：
Tanser F
影响因子：
--
作者：
ANDERSON, RM;MAY, RM
通讯作者：
MAY, RM