Effect of population viral load on prospective HIV incidence in a hyperendemic rural African community.
Effect of population viral load on prospective HIV incidence in a hyperendemic rural African community.
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DOI：
10.1126/scitranslmed.aam8012
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发表时间：
2017-12-13
影响因子：
17.1
通讯作者：
Pillay D
中科院分区：
文献类型：
--
作者：
Tanser F;Vandormael A;Cuadros D;Phillips AN;de Oliveira T;Tomita A;Bärnighausen T;Pillay D
监测HIV人群病毒载量（PVL）已被认为是推断HIV传播潜力和预测特定社区未来新发HIV感染率（HIV发病率）的重要手段。然而，PVL措施和直接测量的艾滋病毒发病率之间的关系尚未在任何情况下量化，最重要的是，在高流行的撒哈拉以南非洲环境。我们使用南非农村夸祖鲁-纳塔尔非洲最大的基于人口的前瞻性人群队列之一评估了这种关系，我们在2011年至2015年期间跟踪了8732名未感染艾滋病毒的参与者。尽管有明确的证据表明，在一些社区的高病毒载量的空间聚集，我们的研究结果表明，PVL指标来自聚合的病毒载量数据，仅从一个特定的社区艾滋病毒阳性成员没有预测艾滋病毒的发病率在这个典型的高流行，农村非洲人口。只有当我们使用修改后的PVL措施，结合病毒载量信息与潜在的空间变化的人口感染的比例（艾滋病毒流行率），我们发现一个一贯的强关系与未来的艾滋病毒感染的风险。例如，具有可检测病毒（PDVP）的人群的总体比例每增加1%，个体获得HIV的风险就增加6.3%（P = 0.001）。在高流行的非洲人口中，这些经修改的PVL指数可以在针对和监测未来艾滋病毒新感染率可能最高的最脆弱社区的干预措施方面发挥关键作用。
Monitoring HIV population viral load (PVL) has been advocated as an important means of inferring HIV transmission potential and predicting the future rate of new HIV infections (HIV incidence) in a particular community. However, the relationship between PVL measures and directly measured HIV incidence has not been quantified in any setting and, most importantly, in a hyperendemic sub-Saharan African setting. We assessed this relationship using one of Africa’s largest population-based prospective population cohorts in rural KwaZulu-Natal, South Africa in which we followed 8732 HIV-uninfected participants between 2011 and 2015. Despite clear evidence of spatial clustering of high viral loads in some communities, our results demonstrate that PVL metrics derived from aggregation of viral load data only from the HIV-positive members of a particular community did not predict HIV incidence in this typical hyperendemic, rural African population. Only once we used modified PVL measures, which combined viral load information with the underlying spatial variation in the proportion of the population infected (HIV prevalence), did we find a consistently strong relationship with future risk of HIV acquisition. For example, every 1% increase in the overall proportion of a population having detectable virus (PDVP) was independently associated with a 6.3% increase in an individual’s risk of HIV acquisition (P = 0.001). In hyperendemic African populations, these modified PVL indices could play a key role in targeting and monitoring interventions in the most vulnerable communities where the future rate of new HIV infections is likely to be highest.
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影响因子：
168.9
作者：
Montaner, Julio S. G.;Lima, Viviane D.;Barrios, Rolando;Yip, Benita;Wood, Evan;Kerr, Thomas;Shannon, Kate;Harrigan, P. Richard;Hogg, Robert S.;Daly, Patricia;Kendall, Peny
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168.9
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作者：
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通讯作者：
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影响因子：
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作者：
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