纽约市 HIV 感染者社区病毒载量的差异。

Disparities in community viral load among HIV-infected persons in New York City.

机构信息

aDivision of Disease Control, New York City Department of Health and Mental Hygiene bFormerly of the HIV Care, Treatment and Housing Program, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene cVermont Department of Health, Burlington, Vermont dLong Island University, School of Health Professions, Brooklyn eHIV Care, Treatment and Housing Program, Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York, USA.

出版信息

AIDS. 2013 Aug 24;27(13):2129-39. doi: 10.1097/QAD.0b013e328360f619.

DOI:10.1097/QAD.0b013e328360f619

PMID:24384591

Abstract

OBJECTIVE

HIV infection is a major problem in New York City (NYC), with more than 100,000 living HIV-infected persons. Novel public health approaches are needed to control the epidemic. The NYC Department of Health and Mental Hygiene (DOHMH) analysed community viral load (CVL) for a baseline to monitor the population-level impact of HIV control interventions.

DESIGN

A cross-sectional study using routinely collected surveillance data.

METHODS

All HIV-infected persons reported to the NYC HIV Registry who were at least 13 years of age, with at least one viral load test result in 2008, and alive at the end of 31 December 2008 were included. CVL was defined as the mean of individual viral load means reported between January and December 2008. Detectable viral load was defined as an individual mean of more than 400 copies/ml. Differences in CVL and proportion undetectable were computed by socio-demographic characteristics and summary measures were mapped.

RESULTS

New York City CVL was 21,318 copies/ml overall (N=62,550) and 44,749 copies/ml (N=28,366) among persons with detectable mean viral loads. CVL varied by demographic and clinical characteristics, with statistically significant differences (P<0.001) in all groups except race/ethnicity (P=0.16). Men, persons aged 20-49 years, MSM, persons with AIDS, those with a CD4 cell count of 200 cells/μl or less and persons diagnosed after 2006 had higher mean viral load. Overall, 54.7% of HIV-infected persons had a suppressed mean viral load, with individual and neighbourhood variations (P<0.0001).

CONCLUSION

This analysis showed strong disparities in reported CVL by individual characteristics and neighbourhoods. CVL patterns can be utilized to target interventions and track their impact.

摘要

目的

HIV 感染是纽约市（NYC）的一个主要问题，有超过 10 万名HIV 感染者。需要采取新的公共卫生措施来控制艾滋病的流行。纽约市卫生局（DOHMH）分析了社区病毒载量（CVL）以作为基线，以监测 HIV 控制干预措施对人群的影响。

设计

使用常规收集的监测数据进行的横断面研究。

方法

所有报告给纽约市 HIV 登记处、年龄至少 13 岁、2008 年至少有一次病毒载量检测结果且在 2008 年 12 月 31 日仍存活的 HIV 感染者均被纳入研究。CVL 定义为 2008 年 1 月至 12 月报告的个体病毒载量均值的平均值。可检测到的病毒载量定义为个体均值超过 400 拷贝/ml。根据社会人口统计学特征计算 CVL 和无法检测到的比例的差异，并绘制汇总指标。

结果

纽约市的 CVL 总体为 21318 拷贝/ml（N=62550），在可检测到平均病毒载量的人群中为 44749 拷贝/ml（N=28366）。CVL 因人口统计学和临床特征而异，除种族/民族（P=0.16）外，所有组均存在统计学差异（P<0.001）。男性、20-49 岁人群、男男性接触者、艾滋病患者、CD4 细胞计数为 200 个/μl 或更低的患者以及 2006 年后诊断的患者的平均病毒载量较高。总体而言，54.7%的 HIV 感染者的平均病毒载量受到抑制，个体和社区之间存在差异（P<0.0001）。