High incidence is not high exposure: what proportion of prevention trial participants are exposed to HIV?
High incidence is not high exposure: what proportion of prevention trial participants are exposed to HIV?
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DOI：
10.1371/journal.pone.0115528
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Brown ER
中科院分区：
文献类型：
--
作者：
Dimitrov D;Donnell D;Brown ER
在高危妇女人群中进行的艾滋病毒预防随机临床试验往往假设所有参与者都有类似的艾滋病毒暴露。然而，参加试验的相当一部分妇女可能没有或很少接触艾滋病毒。我们的目标是估计在整个假设的高风险研究人群中暴露于艾滋病毒的妇女的比例。建立了一个基于个体的随机模型来模拟一组性活跃的未感染艾滋病毒的妇女在艾滋病毒高流行环境中的性行为和感染艾滋病毒的风险。该模型中的关键行为和流行假设是基于已发表的关于南非艾滋病毒传播的研究。对暴露流行率（定义为与感染艾滋病毒的伴侣发生性关系的妇女比例）和艾滋病毒发病率进行了评价。我们的模型预测，在艾滋病毒发病率为每100人年1人的社区，每年只有5-6%的妇女感染艾滋病毒，而在艾滋病毒发病率为每100人年5人的社区，20-25%的妇女感染艾滋病毒。大约70%的新感染者是从携带无症状艾滋病毒的伴侣那里获得的。数学模型表明，即使在发病率很高的情况下，参加艾滋病毒预防试验的妇女中也有很高比例可能未接触艾滋病毒。在计划未来的临床试验时，应仔细分析HIV暴露与其他风险因素之间的关系。
Randomized clinical trials of HIV prevention in high-risk populations of women often assume that all participants have similar exposure to HIV. However, a substantial fraction of women enrolled in the trial may have no or low exposure to HIV. Our objective was to estimate the proportion of women exposed to HIV throughout a hypothetical high-risk study population. A stochastic individual-based model was developed to simulate the sexual behavior and the risk of HIV acquisition for a cohort of sexually active HIV-uninfected women in high HIV prevalence settings. Key behavior and epidemic assumptions in the model were based on published studies on HIV transmission in South Africa. The prevalence of exposure, defined as the proportion of women who have sex with HIV-infected partner, and HIV incidence were evaluated. Our model projects that in communities with HIV incidence rate of 1 per 100 person years, only 5-6% of women are exposed to HIV annually while in communities with an HIV incidence of 5 per 100 person years 20-25% of women are exposed to HIV. Approximately 70% of the new infections are acquired from partners with asymptomatic HIV. Mathematical models suggest that a high proportion of women enrolled in HIV prevention trials may be unexposed to HIV even when incidence rates are high. The relationship between HIV exposure and other risk factors should be carefully analyzed when future clinical trials are planned.
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