Global epidemiology of HIV infection in men who have sex with men.
Global epidemiology of HIV infection in men who have sex with men.
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DOI：
10.1016/s0140-6736(12)60821-6
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发表时间：
2012-07-28
期刊：
影响因子：
168.9
通讯作者：
Brookmeyer, Ron
中科院分区：
文献类型：
--
作者：
Beyrer, Chris;Baral, Stefan D.;van Griensven, Frits;Goodreau, Steven M.;Chariyalertsak, Suwat;Wirtz, Andrea L.;Brookmeyer, Ron
在大多数国家，男男性行为者中艾滋病毒的流行继续扩大。我们试图了解全球MSM流行病的流行病学驱动因素以及为什么它继续有增无减。我们对2007年至2011年MSM中艾滋病毒流行率、发病率、风险因素和艾滋病毒分子流行病学的可用数据进行了全面审查，并使用基于代理的模拟对艾滋病毒传播的动态进行了建模。我们的研究结果表明，通过接受性肛交传播的高概率在解释MSM中不成比例的疾病负担方面具有核心作用。艾滋病毒可以通过大型MSM网络以极快的速度传播。分子流行病学数据显示，艾滋病毒感染在男男性接触者网络中大量聚集，在同一人群中，男男性接触者的双变异和多变异艾滋病毒感染率高于异性恋者。降低生物传播和感染风险的预防战略，如基于抗逆转录病毒药物的方法，为控制男男性行为者中不断扩大的流行病提供了希望，但其潜在效力受到结构性因素的限制，这些因素导致世界许多地区男男性行为者寻求健康的行为减少。
Epidemics of HIV in men who have sex with men (MSM) continue to expand in most countries. We sought to understand the epidemiological drivers of the global epidemic in MSM and why it continues unabated. We did a comprehensive review of available data for HIV prevalence, incidence, risk factors, and the molecular epidemiology of HIV in MSM from 2007 to 2011, and modelled the dynamics of HIV transmission with an agent-based simulation. Our findings show that the high probability of transmission per act through receptive anal intercourse has a central role in explaining the disproportionate disease burden in MSM. HIV can be transmitted through large MSM networks at great speed. Molecular epidemiological data show substantial clustering of HIV infections in MSM networks, and higher rates of dual-variant and multiple-variant HIV infection in MSM than in heterosexual people in the same populations. Prevention strategies that lower biological transmission and acquisition risks, such as approaches based on antiretrovirals, offer promise for controlling the expanding epidemic in MSM, but their potential effectiveness is limited by structural factors that contribute to low health-seeking behaviours in populations of MSM in many parts of the world.