Longitudinal community plasma HIV-1 RNA concentrations and incidence of HIV-1 among injecting drug users: prospective cohort study.
Longitudinal community plasma HIV-1 RNA concentrations and incidence of HIV-1 among injecting drug users: prospective cohort study.
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DOI：
10.1136/bmj.b1649
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发表时间：
2009-04-30
期刊：
影响因子：
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通讯作者：
Montaner JS
中科院分区：
文献类型：
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作者：
Wood E;Kerr T;Marshall BD;Li K;Zhang R;Hogg RS;Harrigan PR;Montaner JS
目的探讨社区注射吸毒人群血浆HIV-1 RNA浓度与HIV感染的关系。设计前瞻性队列研究。背景：加拿大温哥华的内城社区。在1996年5月1日至2007年6月30日期间，每六个月对注射吸毒者（感染和不感染艾滋病毒）进行随访。主要结果测量每位HIV阴性参与者随访前6个月估计的社区血浆HIV-1 RNA。相关的艾滋病毒发病率。结果在622例HIV注射吸毒者中，共检测血浆HIV-1 RNA 12 435次。在1429名未感染艾滋病毒的注射吸毒者中，有155名艾滋病毒血清转化，发病率密度为2.49(95%可信区间2.09 ~ 2.88)/ 100人年。在校正不安全性行为和共用注射器的Cox模型中，估计的社区血浆HIV-1 RNA浓度仍然与HIV血清转化时间独立相关（风险比为3.32(1.82至6.08，P<0.001)，每增加log10）。当随访期限于1988年1月1日之后的观察时（当血浆HIV RNA中位数浓度< 20,000拷贝/ml时），中位病毒载量与HIV发病率不再具有统计学相关性（1.70 (0.79 ~ 3.67，P=0.175)，每增加log10）。结论社区血浆HIV-1 RNA浓度的纵向测量与社区HIV感染率相关，并预测与不安全性行为和共用注射器无关的HIV感染率。如果这些发现得到证实，它们可能有助于为艾滋病毒预防和治疗干预措施提供信息。
Objective To examine the relation between plasma HIV-1 RNA concentrations in the community and HIV incidence among injecting drug users. Design Prospective cohort study. Setting Inner city community in Vancouver, Canada. Participants Injecting drug users, with and without HIV, followed up every six months between 1 May 1996 and 30 June 2007. Main outcome measures Estimated community plasma HIV-1 RNA in the six months before each HIV negative participant’s follow-up visit. Associated HIV incidence. Results Among 622 injecting drug users with HIV, 12 435 measurements of plasma HIV-1 RNA were obtained. Among 1429 injecting drug users without HIV, there were 155 HIV seroconversions, resulting in an incidence density of 2.49 (95% confidence interval 2.09 to 2.88) per 100 person years. In a Cox model that adjusted for unsafe sexual behaviours and sharing used syringes, the estimated community plasma HIV-1 RNA concentration remained independently associated with the time to HIV seroconversion (hazard ratio 3.32 (1.82 to 6.08, P<0.001), per log10 increase). When the follow-up period was limited to observations after 1 January 1988 (when the median plasma HIV RNA concentration was <20 000 copies/ml), the median viral load was no longer statistically associated with HIV incidence (1.70 (0.79 to 3.67, P=0.175), per log10 increase). Conclusions A longitudinal measure of community plasma HIV-1 RNA concentration was correlated with the community HIV incidence rate and predicted HIV incidence independent of unsafe sexual behaviours and sharing used syringes. If these findings are confirmed, they could help to inform both HIV prevention and treatment interventions.