Network-related mechanisms may help explain long-term HIV-1 seroprevalence levels that remain high but do not approach population-group saturation
Network-related mechanisms may help explain long-term HIV-1 seroprevalence levels that remain high but do not approach population-group saturation
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DOI：
10.1093/aje/152.10.913
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发表时间：
2000-11-15
影响因子：
5
通讯作者：
Des Jarlais, DC
中科院分区：
文献类型：
--
作者：
Friedman, SR;Kottiri, BJ;Des Jarlais, DC
在许多城市，注射吸毒者中的人类免疫缺陷病毒(HIV)-1血清阳性率多年来稳定在30%-70%，没有二次爆发，使血清阳性率增加15%或更多。作者考虑了如何将HIV-1发病率保持在适度的血清阳性水平，从而使发病率最高。之前建议的答案包括降低行为风险和高风险亚群中的网络饱和。在1991-1993年研究的767名注射毒品者中，在纽约市血清阳性率稳定高的时期，危险行为仍然普遍，网络远未饱和。作者提出了一种不同的基于网络的机制：在稳定的高流行情况下，连接的血清阴性性子网络的相对较小规模(在包含感染者和未感染者的较大网络中)可能会限制传染病的爆发。任何原发感染暴发可能仅限于血清阴性的相关亚成分的成员，而研究中最大的此类亚成分只有18个成员(415个血清阴性)。研究和数学建模应研究可能影响血清阴性亚组分的大小和稳定性的条件。最后，如果血清阴性的小的相关成分的存在防止了二次暴发，这种保护可能会减弱，如果艾滋病毒-1血清阳性率下降，新暴发的脆弱性就会增加。因此，在流行率下降的情况下，应维持或加强预防方案。
In many cities, human immunodeficiency virus (HIV)-1 seroprevalence among drug injectors stabilizes at 30-70% for many years without secondary outbreaks that increase seroprevalence by 15% or more. The authors considered how HIV-1 incidence can remain moderate at seroprevalence levels that would give maximum incidence. Previously suggested answers include behavioral risk reduction and network saturation within high-risk subgroups. Among 767 drug injectors studied in 1991-1993, during a period of stable high seroprevalence in New York City, risk behaviors remained common, and networks were far from saturated. The authors suggest a different network-based mechanism: in stable high-prevalence situations, the relatively small sizes of subnetworks of linked seronegatives (within larger networks containing both infected and uninfected persons) may limit infectious outbreaks. Any primary infection outbreak would probably be limited to members of connected subcomponents of seronegatives, and the largest such subcomponent in the study contained only 18 members (of 415 seronegatives). Research and mathematical modeling should study conditions that may affect the size and stability of subcomponents of seronegatives. Finally, if the existence of small, connected components of seronegatives prevents secondary outbreaks, this protection may weaken, and vulnerability to new outbreaks increase, if HIV-1 seroprevalence falls. Thus, in situations of declining prevalence, prevention programs should be maintained or strengthened.