NoHIV stage is dominant in driving the HIV epidemic in sub-Saharan Africa
NoHIV stage is dominant in driving the HIV epidemic in sub-Saharan Africa
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DOI：
10.1097/qad.0b013e3282f8af84
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发表时间：
2008-05-31
期刊：
影响因子：
3.8
通讯作者：
Longini, Ira A., Jr.
中科院分区：
文献类型：
--
作者：
Abu-Raddad, Laith J.;Longini, Ira A., Jr.
目的：通过使用 Rakai 研究中每个 HIV 阶段每次性交的 HIV 传播概率的最新测量结果，估计每个 HIV 进展阶段在加剧撒哈拉以南非洲艾滋病毒传播中的作用。 方法：使用以 Rakai、马萨卡和四城市研究的经验数据为参数的数学模型来估计撒哈拉以南非洲两个代表性流行病中每个 HIV 阶段引起的感染比例。第一个环境代表艾滋病毒高流行（肯尼亚基苏木），而第二个环境代表普遍但非高地方性艾滋病毒流行（喀麦隆雅温得）。结果：我们估计基苏木的艾滋病毒传播分别有 17%、51% 和 32% 是由于急性期、潜伏期和晚期阶段的指示病例造成的。在雅温得，这一比例分别为 25%、44% 和 31%。我们发现，每个阶段的相对贡献随着疫情的演变而变化，早期阶段以急性阶段为主，感染集中在高危人群中，而晚期阶段则在疫情成熟稳定时发挥主要作用。潜伏期的贡献在整个流行期间基本保持稳定，约占所有传播的一半。结论：虽然潜伏期提供了最大的贡献，但没有艾滋病毒阶段在流行中占主导地位。每个阶段的作用取决于流行病的阶段以及艾滋病毒传播人群中性危险行为的普遍水平。 These findings may influence the design and implementation of different HIV interventions. (C) 2008 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
Objective: To estimate the role of each of the HIV progression stages in fueling HIV transmission in sub-Saharan Africa by using the recent measurements of HIV transmission probability per coital per HIV stage in the Rakai study.Methods: A mathematical model, parameterized by empirical data from the Rakai, Masaka, and Four-City studies, was used to estimate the proportion of infections due to each of the HIV stages in two representative epidemics in sub-Saharan Africa. The first setting represents a hyperendemic HIV epidemic (Kisumu, Kenya) whereas the second setting represents a generalized but not hyperendemic HIV epidemic (Yaounde, Cameroon).Results: We estimate that 17, 51, and 32% of HIV transmissions in Kisumu were due to index cases in their acute, latent, and late stages, respectively. In Yaounde, the fractions were 25, 44, and 31%. We found that the relative contribution of each stage varied with the epidemic evolution with the acute stage prevailing early on when the infection is concentrated in the high-risk groups with the late stage playing a major role as the epidemic matured and stabilized. The latent stage contribution remained largely stable throughout the epidemic and contributed about half of all transmissions.Conclusion: No HIV stage dominated the epidemical though the latent stage provided the largest contribution. The role of each stage depends on the phase of the epidemic and on the prevailing levels of sexual risk behavior in the populations in which HIV is spreading. These findings may influence the design and implementation of different HIV interventions. (C) 2008 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.