Measuring population transmission risk for HIV: an alternative metric of exposure risk in men who have sex with men (MSM) in the US.
Measuring population transmission risk for HIV: an alternative metric of exposure risk in men who have sex with men (MSM) in the US.
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DOI：
10.1371/journal.pone.0053284
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Sullivan PS
中科院分区：
文献类型：
--
作者：
Kelley CF;Rosenberg ES;O'Hara BM;Frew PM;Sanchez T;Peterson JL;Del Rio C;Sullivan PS
艾滋病毒负担和治疗成功的各种指标[如艾滋病毒流行率，社区病毒载量（CVL），人口病毒载量（PVL），病毒载量无法检测的艾滋病毒阳性者的百分比]对理解差异具有重要的公共卫生限制。使用正在进行的艾滋病毒发病率队列的黑人和白色男性与男性发生性关系（MSM）的数据，我们提出了一个新的衡量标准，以衡量那些在传播艾滋病毒的风险，并说明其价值。血浆VL>400拷贝/mL的MSM被定义为具有“传播风险”。我们计算了黑人和白色MSM的HIV流行率、CVL、PVL、病毒载量检测不到的HIV阳性者的百分比以及血浆VL>400拷贝/ml（%VL 400）的流行率。我们使用蒙特卡罗模拟结合种族的性混合数据，估计暴露的黑人和白色艾滋病毒阴性的男男性行为者的合作伙伴通过无保护的肛交（UAI）的传播风险。在招募的709名男男性行为者中，42%（168/399）的黑人男男性行为者和14%（44/310）的白色男男性行为者艾滋病毒检测呈阳性（p<0.0001）。在CVL、PVL或病毒载量检测不到的HIV阳性百分比方面没有观察到显著差异。黑人的%VL400为25%（98/393），而白色MSM为8%（25/310）（p<.0001）。估计有2个UAI伴侣的黑人MSM有40%的概率（95% CI：35%，45%）有≥1个UAI伴侣有传播风险，而白色MSM有20%的概率（CI：15%，24%）。尽管在其他指标上有相似之处，但我们队列中的黑人男男性行为者有艾滋病毒传播风险的可能性是白色男男性行为者的三倍。与类似的风险行为，艾滋病毒阴性的黑人男男性行为者有相当高的可能性遇到UAI合作伙伴在传播艾滋病毒的风险。我们的研究结果支持增加艾滋病毒检测，与护理的联系，以及对艾滋病毒阳性男男性行为者的抗逆转录病毒治疗，以降低那些有传播风险的人的患病率，特别是黑人男男性行为者。
Various metrics for HIV burden and treatment success [e.g. HIV prevalence, community viral load (CVL), population viral load (PVL), percent of HIV-positive persons with undetectable viral load] have important public health limitations for understanding disparities. Using data from an ongoing HIV incidence cohort of black and white men who have sex with men (MSM), we propose a new metric to measure the prevalence of those at risk of transmitting HIV and illustrate its value. MSM with plasma VL>400 copies/mL were defined as having ‘transmission risk’. We calculated HIV prevalence, CVL, PVL, percent of HIV-positive with undetectable viral loads, and prevalence of plasma VL>400 copies/ml (%VL400) for black and white MSM. We used Monte Carlo simulation incorporating data on sexual mixing by race to estimate exposure of black and white HIV-negative MSM to a partner with transmission risk via unprotected anal intercourse (UAI). Of 709 MSM recruited, 42% (168/399) black and 14% (44/310) white MSM tested HIV-positive (p<.0001). No significant differences were seen in CVL, PVL, or percent of HIV positive with undetectable viral loads. The %VL400 was 25% (98/393) for black vs. 8% (25/310) for white MSM (p<.0001). Black MSM with 2 UAI partners were estimated to have 40% probability (95% CI: 35%, 45%) of having ≥1 UAI partner with transmission risk vs. 20% for white MSM (CI: 15%, 24%). Despite similarities in other metrics, black MSM in our cohort are three times as likely as white MSM to have HIV transmission risk. With comparable risk behaviors, HIV-negative black MSM have a substantially higher likelihood of encountering a UAI partner at risk of transmitting HIV. Our results support increasing HIV testing, linkage to care, and antiretroviral treatment of HIV-positive MSM to reduce prevalence of those with transmission risk, particularly for black MSM.
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