Identifying Risk Factors for Recent HIV Infection in Kenya Using a Recent Infection Testing Algorithm: Results from a Nationally Representative Population-Based Survey.
Identifying Risk Factors for Recent HIV Infection in Kenya Using a Recent Infection Testing Algorithm: Results from a Nationally Representative Population-Based Survey.
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DOI：
10.1371/journal.pone.0155498
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
2007 KAIS study group
中科院分区：
文献类型：
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作者：
Kim AA;Parekh BS;Umuro M;Galgalo T;Bunnell R;Makokha E;Dobbs T;Murithi P;Muraguri N;De Cock KM;Mermin J;2007 KAIS study group
可以区分近期和长期艾滋病毒感染的近期感染检测算法（RITA）可以应用于全国代表性的基于人口的调查，以表征和确定一个国家近期感染的风险因素。我们应用了RITA使用限制性抗原亲合力酶免疫测定（LAg）储存的HIV阳性样本从2007年肯尼亚艾滋病指标调查。近期感染的病例定义包括近期LAg检测和无抗逆转录病毒治疗使用证据。进行多变量分析，以确定与最近和长期感染的艾滋病毒未感染者相比，相关的因素。对所有估计值进行加权，以调整抽样概率和无应答。在1，025份HIV抗体阳性标本中，64份（6.2%）符合近期感染的病例定义，961份（93.8%）符合长期感染的病例定义。与未感染艾滋病毒的个体相比，与近期感染调整后几率较高相关的因素是居住在内罗毕（校正比值比[AOR] 11.37;置信区间[CI] 2.64 - 48.87）和尼扬扎（AOR 4.55; CI 1.39 - 14.89）省份与西部省份相比;丧偶（AOR 8.04; CI 1.42 - 45.50）或已婚（AOR 6.42; CI 1.55 - 26.58）与从未结婚相比;在过去一年中有≥ 2个性伴侣（AOR 2.86; CI 1.51 - 5.41）;过去一年中最后一次性交时未使用避孕套（AOR 1.61; CI 1.34 - 1.93）;在过去一年中报告性传播感染（STI）诊断或STI症状（AOR 1.97; CI 1.05 - 8.37）;和年龄<30岁，具有：1）HSV-2感染（AOR 8.84; CI 2.62 - 29.85），2）男性生殖器溃疡疾病（AOR 8.70; CI 2.36 - 32.08），或3）缺乏男性包皮环切术（AOR 17.83; CI 2.19 - 144.90）。与未感染艾滋病毒的人相比，与长期感染的调整几率较高相关的因素包括居住在海岸（AOR 1.55; CI 1.04 - 2.32）和尼扬扎（AOR 2.33; CI 1.67 - 3.25）与西部省相比的省份;分居/离婚（AOR 1.87; CI 1.16 - 3.01）或丧偶（AOR 2.83; CI 1.78 - 4.45）与从未结婚;曾经使用过避孕套（AOR 1.61; CI 1.34 - 1.93）;以及在过去一年中有STI诊断或STI症状（AOR 1.89; CI 1.20 - 2.97）相比。与长期感染的调整后几率较低相关的因素包括在过去一年中最后一次性行为时使用避孕套（AOR 0.47; CI 0.36 - 0.61），年龄<30岁时无HSV 2感染（AOR 0.38; CI 0.20 - 0.75）或年龄<30岁未行包皮环切术的男性（AOR 0.30; CI 0.15 - 0.61）。我们使用RITA对一项全国代表性调查中采集的血液标本进行分析，确定了与近期和长期HIV感染风险增加相关的因素。虽然我们的样本中可能存在一些假的近期病例，但确定的近期感染相关性在流行病学和生物学上是合理的。这些方法可以作为其他流行病相似的国家的模式，为旨在大幅减少人口新感染的有针对性的联合预防战略提供信息。
A recent infection testing algorithm (RITA) that can distinguish recent from long-standing HIV infection can be applied to nationally representative population-based surveys to characterize and identify risk factors for recent infection in a country. We applied a RITA using the Limiting Antigen Avidity Enzyme Immunoassay (LAg) on stored HIV-positive samples from the 2007 Kenya AIDS Indicator Survey. The case definition for recent infection included testing recent on LAg and having no evidence of antiretroviral therapy use. Multivariate analysis was conducted to determine factors associated with recent and long-standing infection compared to HIV-uninfected persons. All estimates were weighted to adjust for sampling probability and nonresponse. Of 1,025 HIV-antibody-positive specimens, 64 (6.2%) met the case definition for recent infection and 961 (93.8%) met the case definition for long-standing infection. Compared to HIV-uninfected individuals, factors associated with higher adjusted odds of recent infection were living in Nairobi (adjusted odds ratio [AOR] 11.37; confidence interval [CI] 2.64–48.87) and Nyanza (AOR 4.55; CI 1.39–14.89) provinces compared to Western province; being widowed (AOR 8.04; CI 1.42–45.50) or currently married (AOR 6.42; CI 1.55–26.58) compared to being never married; having had ≥ 2 sexual partners in the last year (AOR 2.86; CI 1.51–5.41); not using a condom at last sex in the past year (AOR 1.61; CI 1.34–1.93); reporting a sexually transmitted infection (STI) diagnosis or symptoms of STI in the past year (AOR 1.97; CI 1.05–8.37); and being aged <30 years with: 1) HSV-2 infection (AOR 8.84; CI 2.62–29.85), 2) male genital ulcer disease (AOR 8.70; CI 2.36–32.08), or 3) lack of male circumcision (AOR 17.83; CI 2.19–144.90). Compared to HIV-uninfected persons, factors associated with higher adjusted odds of long-standing infection included living in Coast (AOR 1.55; CI 1.04–2.32) and Nyanza (AOR 2.33; CI 1.67–3.25) provinces compared to Western province; being separated/divorced (AOR 1.87; CI 1.16–3.01) or widowed (AOR 2.83; CI 1.78–4.45) compared to being never married; having ever used a condom (AOR 1.61; CI 1.34–1.93); and having a STI diagnosis or symptoms of STI in the past year (AOR 1.89; CI 1.20–2.97). Factors associated with lower adjusted odds of long-standing infection included using a condom at last sex in the past year (AOR 0.47; CI 0.36–0.61), having no HSV2-infection at aged <30 years (AOR 0.38; CI 0.20–0.75) or being an uncircumcised male aged <30 years (AOR 0.30; CI 0.15–0.61). We identified factors associated with increased risk of recent and longstanding HIV infection using a RITA applied to blood specimens collected in a nationally representative survey. Though some false-recent cases may have been present in our sample, the correlates of recent infection identified were epidemiologically and biologically plausible. These methods can be used as a model for other countries with similar epidemics to inform targeted combination prevention strategies aimed to drastically decrease new infections in the population.