Determinants of HIV-1 transmission in men who have sex with men: a combined clinical, epidemiological and phylogenetic approach
Determinants of HIV-1 transmission in men who have sex with men: a combined clinical, epidemiological and phylogenetic approach
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DOI：
10.1097/qad.0b013e32833ac9e6
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发表时间：
2010-07-01
期刊：
影响因子：
3.8
通讯作者：
Pillay, Deenan
中科院分区：
文献类型：
--
作者：
Fisher, Martin;Pao, David;Pillay, Deenan
目的：确定与男男性行为者（MSM）中HIV传播相关的生物学因素。设计：结合临床和流行病学数据，对男男性行为者队列中HIV-1的纵向系统发育分析。方法：2000年至2006年间在性健康诊所就诊的潜在hiv感染者。对个体进行分类，以便他们可以从近期感染类别转移到慢性感染类别。从血浆病毒或原病毒DNA和聚类中获得HIV-1pol基因序列，通过最大似然和保守遗传距离差异估计。确定了导致每次最近感染的最可能的单一传播源，并使用泊松回归模型探索了可能传播时间前后的风险因素。结果：1144例hiv感染者中，859例（75%）获得了pol序列数据；859人中有159人（19%）在诊断时最近感染了艾滋病毒。159人中有41人（26%）被确定为单一最可能的传播者，其中11人最近被感染（27%），30人被慢性感染。多变量分析中与传播相关的因素为：年龄较小{每5岁发病率比0.68[95%可信区间（CI） 0.54 ~ 0.86]， P=0.0009}，较高的病毒载量[每log发病率比1.61 (95% CI 1.15 ~ 2.25)， P=0.005]，近期感染[发病率比3.88 (95% CI 1.76 ~ 8.55), P_0.0008]和近期性传播疾病[发病率比5.32 (95% CI 2.51 ~ 11.29)， P=0.0001]。在单变量模型中，HAART具有高度保护作用，RR为0.14 （95% CI 0.07-0.27， P=0.0001）。结论：MSM中HIV的进一步传播与近期感染、性传播疾病和较高的病毒载量显著相关，有效的HAART可降低HIV的传播。大多数新感染似乎发生在传播时未确诊感染的个人身上。(C) 2010年Wolters Kluwer Health垂直条Lippincott Williams & Wilkins
Objectives: To identify biological factors associated with HIV transmission in men who have sex with men (MSM).Design: A longitudinal phylogenetic analysis of HIV-1 from an MSM cohort, incorporating clinical and epidemiological data.Methods: Potential individuals were HIV-infected MSM attending a sexual health clinic between 2000 and 2006. Individuals were classified such that they could move from recent to chronic infection categories. HIV-1pol gene sequences were obtained from plasma virus or proviral DNA and clusters estimated by maximum likelihood and conservative genetic distance differences. The single most likely transmitter generating each recent infection was ascertained and risk factors around time of likely transmission explored using Poisson regression modelling.Results: Out of 1144 HIV-infected MSM, pol sequence data were obtained for 859 (75%); 159 out of 859 (19%) were recently HIV infected at diagnosis. A single most likely transmitter was identified for 41 out of 159 (26%), of which 11 were recently infected (27%) and 30 chronically infected. Factors associated with transmission in multivariable analysis were: younger age {rate ratio per 5 years older 0.68 [95% confidence interval (CI) 0.54-0.86], P=0.0009}, higher viral load [rate ratio per log higher 1.61 (95% CI 1.15-2.25), P=0.005], recent infection [rate ratio 3.88 (95% CI 1.76-8.55), P_0.0008] and recent sexually transmitted disease [rate ratio 5.32 (95% CI 2.51-11.29), P=0.0001]. HAART was highly protective in a univariable model, RR 0.14 (95% CI 0.07-0.27, P=0.0001).Conclusion: Onward transmission of HIV among MSM is significantly associated with recent infection, sexually transmitted diseases and higher viral load, and reduced by effective HAART. The majority of new infections appear to occur from individuals whose infection was undiagnosed at the time of transmission. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins