测量 HIV 人群传播风险：美国男男性行为者（MSM）暴露风险的替代指标。
Measuring population transmission risk for HIV: an alternative metric of exposure risk in men who have sex with men (MSM) in the US.
机构信息
Department of Medicine, Emory University, Atlanta, Georgia, United States of America.
出版信息
PLoS One. 2012;7(12):e53284. doi: 10.1371/journal.pone.0053284. Epub 2012 Dec 28.
BACKGROUND
Various metrics for HIV burden and treatment success [e.g. HIV prevalence, community viral load (CVL), population viral load (PVL), percent of HIV-positive persons with undetectable viral load] have important public health limitations for understanding disparities.
METHODS AND FINDINGS
Using data from an ongoing HIV incidence cohort of black and white men who have sex with men (MSM), we propose a new metric to measure the prevalence of those at risk of transmitting HIV and illustrate its value. MSM with plasma VL>400 copies/mL were defined as having 'transmission risk'. We calculated HIV prevalence, CVL, PVL, percent of HIV-positive with undetectable viral loads, and prevalence of plasma VL>400 copies/ml (%VL400) for black and white MSM. We used Monte Carlo simulation incorporating data on sexual mixing by race to estimate exposure of black and white HIV-negative MSM to a partner with transmission risk via unprotected anal intercourse (UAI). Of 709 MSM recruited, 42% (168/399) black and 14% (44/310) white MSM tested HIV-positive (p<.0001). No significant differences were seen in CVL, PVL, or percent of HIV positive with undetectable viral loads. The %VL400 was 25% (98/393) for black vs. 8% (25/310) for white MSM (p<.0001). Black MSM with 2 UAI partners were estimated to have 40% probability (95% CI: 35%, 45%) of having ≥1 UAI partner with transmission risk vs. 20% for white MSM (CI: 15%, 24%).
DISCUSSION
Despite similarities in other metrics, black MSM in our cohort are three times as likely as white MSM to have HIV transmission risk. With comparable risk behaviors, HIV-negative black MSM have a substantially higher likelihood of encountering a UAI partner at risk of transmitting HIV. Our results support increasing HIV testing, linkage to care, and antiretroviral treatment of HIV-positive MSM to reduce prevalence of those with transmission risk, particularly for black MSM.
背景
用于衡量 HIV 负担和治疗效果的各种指标（如 HIV 流行率、社区病毒载量 (CVL)、人群病毒载量 (PVL)、HIV 阳性者中无法检测到病毒载量的比例）对于理解差异存在重要的公共卫生局限性。
方法和发现
我们利用一项正在进行的黑人和男男性行为者（MSM）艾滋病毒发病率队列的数据，提出了一种新的指标来衡量具有 HIV 传播风险的人群的流行率，并说明了其价值。血浆 VL>400 拷贝/毫升的 MSM 被定义为具有“传播风险”。我们计算了黑人和白人 MSM 的 HIV 流行率、CVL、PVL、无法检测到病毒载量的 HIV 阳性者比例和血浆 VL>400 拷贝/ml 的流行率（%VL400）。我们使用包含按种族进行性混合数据的蒙特卡罗模拟来估计黑人 HIV 阴性 MSM 和白人 HIV 阴性 MSM 通过无保护肛交（UAI）接触具有传播风险的伴侣的暴露情况。在招募的 709 名 MSM 中，42%（168/399）的黑人 MSM 和 14%（44/310）的白人 MSM 艾滋病毒检测呈阳性（p<.0001）。在 CVL、PVL 或无法检测到病毒载量的 HIV 阳性者比例方面没有显著差异。黑人 MSM 的%VL400 为 25%（98/393），而白人 MSM 为 8%（25/310）（p<.0001）。估计黑人 MSM 与 2 个 UAI 伴侣发生性关系的可能性有 40%（95%CI：35%，45%）至少有 1 个 UAI 伴侣具有传播风险，而白人 MSM 的可能性为 20%（CI：15%，24%）。
讨论
尽管在其他指标上存在相似之处，但我们队列中的黑人 MSM 具有 HIV 传播风险的可能性是白人 MSM 的三倍。在具有类似风险行为的情况下，HIV 阴性的黑人 MSM 遇到具有 HIV 传播风险的 UAI 伴侣的可能性要高得多。我们的结果支持增加 HIV 检测、将 HIV 阳性 MSM 与护理联系起来以及进行抗逆转录病毒治疗，以降低具有传播风险者的比例，尤其是黑人 MSM。
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