Hoenigl Martin, Weibel Nadir, Mehta Sanjay R, Anderson Christy M, Jenks Jeffrey, Green Nella, Gianella Sara, Smith Davey M, Little Susan J
Division of Infectious Diseases, University of California, San Diego Section of Infectious Diseases and Tropical Medicine Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria.
Department of Computer Science and Engineering, University of California, San Diego.
Clin Infect Dis. 2015 Aug 1;61(3):468-75. doi: 10.1093/cid/civ335. Epub 2015 Apr 22.
Although men who have sex with men (MSM) represent a dominant risk group for human immunodeficiency virus (HIV), the risk of HIV infection within this population is not uniform. The objective of this study was to develop and validate a score to estimate incident HIV infection risk.
Adult MSM who were tested for acute and early HIV (AEH) between 2008 and 2014 were retrospectively randomized 2:1 to a derivation and validation dataset, respectively. Using the derivation dataset, each predictor associated with an AEH outcome in the multivariate prediction model was assigned a point value that corresponded to its odds ratio. The score was validated on the validation dataset using C-statistics.
Data collected at a single HIV testing encounter from 8326 unique MSM were analyzed, including 200 with AEH (2.4%). Four risk behavior variables were significantly associated with an AEH diagnosis (ie, incident infection) in multivariable analysis and were used to derive the San Diego Early Test (SDET) score: condomless receptive anal intercourse (CRAI) with an HIV-positive MSM (3 points), the combination of CRAI plus ≥5 male partners (3 points), ≥10 male partners (2 points), and diagnosis of bacterial sexually transmitted infection (2 points)-all as reported for the prior 12 months. The C-statistic for this risk score was >0.7 in both data sets.
The SDET risk score may help to prioritize resources and target interventions, such as preexposure prophylaxis, to MSM at greatest risk of acquiring HIV infection. The SDET risk score is deployed as a freely available tool at http://sdet.ucsd.edu.
尽管男男性行为者（MSM）是人类免疫缺陷病毒（HIV）的主要风险群体，但该人群中HIV感染风险并不一致。本研究的目的是开发并验证一个用于估计HIV感染风险的评分系统。
对2008年至2014年间接受急性和早期HIV（AEH）检测的成年男男性行为者进行回顾性随机分组，分别以2:1的比例分为推导数据集和验证数据集。利用推导数据集，将多变量预测模型中与AEH结果相关的每个预测因素赋予一个与其比值比相对应的分值。使用C统计量在验证数据集上对该评分进行验证。
分析了从8326名不同男男性行为者的单次HIV检测中收集的数据，其中200人患有AEH（2.4%）。在多变量分析中，四个风险行为变量与AEH诊断（即新发感染）显著相关，并用于推导圣地亚哥早期检测（SDET）评分：与HIV阳性男男性行为者发生无保护肛交（CRAI）（3分）、CRAI加上≥5名男性性伴侣（3分）、≥10名男性性伴侣（2分）以及细菌性性传播感染诊断（2分）——均为过去12个月内报告的情况。该风险评分在两个数据集中的C统计量均>0.7。
SDET风险评分可能有助于对资源进行优先排序，并针对感染HIV风险最高的男男性行为者开展暴露前预防等干预措施。SDET风险评分可在http://sdet.ucsd.edu上作为免费工具使用。
