Hoare Alexander, Wilson David P, Regan David G, Kaldor John, Law Matthew G
National Centre in HIV Epidemiology and Clinical Research, Faculty of Medicine, University of New South Wales, Level 2, 376 Victoria Street, Sydney, NSW 2010, Australia.
Sex Health. 2008 Jun;5(2):169-87. doi: 10.1071/sh07099.
Since 1999 there has been an increase in the number of HIV diagnoses in Australia, predominantly among men who have sex with men (MSM), but the magnitude of increase differs between states: approximately 7% rise in New South Wales, approximately 96% rise in Victoria, and approximately 68% rise in Queensland.
Epidemiological, clinical, behavioural and biological data were collated into a mechanistic mathematical model to explore possible reasons for this increase in HIV notifications in MSM. The model was then used to make projections to 2015 under various scenarios.
The model suggests that trends in clinical and behavioural parameters, including increases in unprotected anal intercourse, cannot explain the magnitude of the observed rise in HIV notifications, without a substantial increase in a 'transmission-increasing' factor. We suggest that a highly plausible biological factor is an increase in the prevalence of other sexually transmissible infections (STI). It was found that New South Wales required an approximately 2-fold increase in other STI to match the data, Victoria needed an ~11-fold increase, and Queensland required an approximately 9-fold increase. This is consistent with observed trends in Australia for some STI in recent years. Future projections also indicate that the best way to control the current rise in HIV notifications is to reduce the prevalence of other STI and to promote condom use, testing for HIV, and initiation of early treatment in MSM diagnosed during primary infection.
Our model can explain the recent rise in HIV notifications with an increase in the prevalence of other STI. This analysis highlights that further investigation into the causes and impact of other STI is warranted in Australia, particularly in Victoria.
自1999年以来，澳大利亚艾滋病毒诊断病例数有所增加，主要集中在男男性行为者（MSM）中，但各州的增长幅度有所不同：新南威尔士州约增长7%，维多利亚州约增长96%，昆士兰州约增长68%。
将流行病学、临床、行为和生物学数据整理成一个机制性数学模型，以探究男男性行为者中艾滋病毒报告病例数增加的可能原因。然后利用该模型对不同情景下到2015年的情况进行预测。
该模型表明，临床和行为参数的趋势，包括无保护肛交的增加，无法解释观察到的艾滋病毒报告病例数上升幅度，除非“传播增加”因素大幅增加。我们认为，一个高度可信的生物学因素是其他性传播感染（STI）患病率的增加。研究发现，新南威尔士州其他性传播感染患病率需要增加约2倍才能与数据相符，维多利亚州需要增加约11倍，昆士兰州需要增加约9倍。这与澳大利亚近年来某些性传播感染的观察趋势一致。未来预测还表明，控制当前艾滋病毒报告病例数上升的最佳方法是降低其他性传播感染的患病率，促进使用避孕套、进行艾滋病毒检测，并对初次感染时被诊断出的男男性行为者尽早开始治疗。
我们的模型可以用其他性传播感染患病率的增加来解释近期艾滋病毒报告病例数的上升。该分析强调，在澳大利亚，特别是在维多利亚州，有必要进一步调查其他性传播感染的原因和影响。
