Wang Xicheng, Wu Yasong, Mao Lin, Xia Wei, Zhang Weiwei, Dai Lili, Mehta Sanjay R, Wertheim Joel O, Dong Xingqi, Zhang Tong, Wu Hao, Smith Davey M
Department of Infectious Diseases, Yunnan Provincial Hospital of Infectious Diseases, Kunming.
Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing.
Clin Infect Dis. 2015 Nov 1;61(9):1462-8. doi: 10.1093/cid/civ526. Epub 2015 Jun 30.
Molecular epidemiology can be useful in identifying clusters of human immunodeficiency virus (HIV) transmission that can be targeted for prevention.
Regular screening of 2000 men who have sex with men (MSM) in Beijing, China, for HIV infection every 2 months identified 179 primary infections (2007-2010). HIV-1 pol sequences were obtained and used to infer the transmission network and identify transmitted drug resistance (TDR) among these individuals. We evaluated the use of clinical and network information to target prevention efforts. Prevention efficiency was calculated as the number of infections saved per number of interventions.
This cohort was infected with HIV-1 subtype B (28%), circulating recombinant form (CRF)_01 AE (53%), and CRF_07 BC (16%). The overall rate of TDR was low (5%), but the rate of clustering was high (64%), suggesting deep sampling of the subnetwork. Provision of a theoretically high-efficacy intervention like antiretroviral therapy to all participants had a prevention efficiency of 23%. The efficiency of targeting prevention based on lower CD4 counts (<200 cells/mL, <350 cells/mL, or <500 cells/mL) and higher viral loads (>100 000 copies/mL and >50 000 copies/mL) was between 10% and 18%. The efficiency of targeting prevention based on number of network connections was much higher (30%-42%). For example, treating the 33 participants with ≥5 connections in 2009 would have theoretically prevented 14 infections in 2010 (42% prevention efficiency).
Regular HIV testing of MSM in Beijing can deeply sample the local transmission subnetwork, and targeting prevention efforts based on network connectivity may be an efficient way to deliver prevention interventions.
分子流行病学有助于识别可作为预防目标的人类免疫缺陷病毒（HIV）传播集群。
在中国北京，每2个月对2000名男男性行为者（MSM）进行HIV感染定期筛查，共发现179例原发感染（2007 - 2010年）。获取HIV-1 pol序列并用于推断传播网络，识别这些个体中的传播耐药性（TDR）。我们评估了利用临床和网络信息来确定预防工作目标的情况。预防效率的计算方法是每干预次数所挽救的感染数。
该队列感染的HIV-1亚型为B型（28%）、循环重组型（CRF）_01 AE（53%）和CRF_07 BC（16%）。总体TDR率较低（5%），但聚集率较高（64%），提示对子网进行了深度抽样。对所有参与者提供理论上高效的干预措施如抗逆转录病毒疗法，预防效率为23%。基于较低CD4细胞计数（<200个细胞/毫升、<350个细胞/毫升或<500个细胞/毫升）和较高病毒载量（>100000拷贝/毫升和>50000拷贝/毫升）来确定预防目标的效率在10%至18%之间。基于网络连接数来确定预防目标的效率要高得多（30% - 42%）。例如，在2009年对33名有≥5个连接的参与者进行治疗，理论上可在2010年预防14例感染（预防效率为42%）。
在北京对MSM进行定期HIV检测可深度抽样本地传播子网，基于网络连通性来确定预防工作目标可能是提供预防干预措施的有效方式。
