Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Lancet Infect Dis. 2013 May;13(5):459-64. doi: 10.1016/S1473-3099(12)70314-6. Epub 2013 Mar 25.
Community viral load, defined as an aggregation of individual viral loads of people infected with HIV in a specific community, has been proposed as a useful measure to monitor HIV treatment uptake and quantify its effect on transmission. The first reports of community viral load were published in 2009, and the measure was subsequently incorporated into the US National HIV/AIDS Strategy. Although intuitively an appealing strategy, measurement of community viral load has several theoretical limitations and biases that need further assessment, which can be grouped into four categories: issues of selection and measurement, the importance of HIV prevalence in determining the potential for ongoing HIV transmission, interpretation of community viral load and its effect on ongoing HIV transmission in a community, and the ecological fallacy (ie, ecological bias). These issues need careful assessment as community viral load is being considered as a public health measurement to assess the effect of HIV care on prevention.
社区病毒载量，定义为特定社区中感染 HIV 的个体病毒载量的总和，被提议作为一种有用的监测 HIV 治疗效果和量化其对传播影响的指标。社区病毒载量的首次报告于 2009 年发表，此后该指标被纳入美国国家艾滋病战略。虽然从直观上看，这是一种很有吸引力的策略，但社区病毒载量的测量存在一些理论上的局限性和偏差，需要进一步评估，这些问题可以分为四类：选择和测量的问题、HIV 流行率在确定持续 HIV 传播潜力方面的重要性、对社区病毒载量的解释及其对社区中持续 HIV 传播的影响，以及生态学谬误（即生态偏差）。由于社区病毒载量被认为是评估 HIV 护理对预防效果的公共卫生测量指标，因此需要仔细评估这些问题。
