Using Molecular HIV Surveillance Data to Understand Transmission Between Subpopulations in the United States.
Using Molecular HIV Surveillance Data to Understand Transmission Between Subpopulations in the United States.
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DOI：
10.1097/qai.0000000000000809
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发表时间：
2015-12-01
期刊：
影响因子：
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通讯作者：
Hall HI
中科院分区：
文献类型：
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作者：
Oster AM;Wertheim JO;Hernandez AL;Ocfemia MC;Saduvala N;Hall HI
研究艾滋病毒传播网络可以深入了解艾滋病毒的传播和干预机会。我们确定了美国风险群体和种族/民族群体之间的传播动态。对于2001-2012年期间报告给美国国家艾滋病监测系统的HIV-1 pol序列，我们计算了成对遗传距离，确定了连锁的序列对（距离≤1.5%的序列），并检查了这些潜在传播伙伴的传播类别和种族/民族。在40，950个序列中，12，910个（32%）与≥1个其他序列连锁。在与男性发生性关系的男性（MSM）中，与≥1个序列连锁的人中，88%与其他MSM连锁，只有4%与异性恋女性连锁。在我们确定潜在传播伙伴的异性恋妇女中，29%与男男性行为者有关，21%与异性恋男子有关，12%与注射毒品者有关。年长和黑人男男性接触者更有可能与异性恋女性联系在一起。所有种族/族裔群体都存在分类混合; 81%的黑人/非裔美国人与其他黑人有关。这项分析是第一次使用美国的监测数据来推断艾滋病毒的传播网络。我们的数据表明，异性恋女性中的艾滋病毒感染主要来自男男性接触者，其次是异性恋男性。尽管很少有男男性行为者与女性有关，这表明少数男男性行为者参与了与异性恋女性的传播，但这些传播在异性恋女性感染艾滋病毒中占很大比例。减少涉及男男性行为者的传播的干预措施也可能减少其他风险群体中的艾滋病毒感染。
Studying HIV transmission networks provides insight into the spread of HIV and opportunities for intervention. We identified transmission dynamics among risk groups and racial/ethnic groups in the United States. For HIV-1 pol sequences reported to the U.S. National HIV Surveillance System during 2001–2012, we calculated pairwise genetic distance, identified linked pairs of sequences (those with distance ≤1.5%), and examined transmission category and race/ethnicity of these potential transmission partners. Of 40,950 sequences, 12,910 (32%) linked to ≥1 other sequence. Of men who have sex with men (MSM) who linked to ≥1 sequence, 88% were linked to other MSM and only 4% were linked to heterosexual women. Of heterosexual women for whom we identified potential transmission partners, 29% linked to MSM, 21% to heterosexual men, and 12% to persons who inject drugs. Older and black MSM were more likely to be linked to heterosexual women. Assortative mixing was present for all racial/ethnic groups; 81% of blacks/African Americans linked to other blacks. This analysis is the first use of U.S. surveillance data to infer an HIV transmission network. Our data suggest that HIV infections among heterosexual women predominantly originate from MSM, followed by heterosexual men. Although few MSM were linked to women, suggesting that a minority of MSM are involved in transmission with heterosexual women, these transmissions represent a substantial proportion of HIV acquisitions by heterosexual women. Interventions that reduce transmissions involving MSM are likely to also reduce HIV acquisition among other risk groups.