Gopalappa Chaitra, Farnham Paul G, Chen Yao-Hsuan, Sansom Stephanie L
University of Massachusetts Amherst, Amherst, MA, USA (CG).
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA (PGF, YC, SLS).
Med Decis Making. 2017 Feb;37(2):224-233. doi: 10.1177/0272989X16668509. Epub 2016 Sep 26.
HIV transmission is the result of complex dynamics in the risk behaviors, partnership choices, disease stage and position along the HIV care continuum-individual characteristics that themselves can change over time. Capturing these dynamics and simulating transmissions to understand the chief sources of transmission remain important for prevention.
The Progression and Transmission of HIV/AIDS (PATH 2.0) is an agent-based model of a sample of 10,000 people living with HIV (PLWH), who represent all men who have sex with men (MSM) and heterosexuals living with HIV in the U.S.A. Persons uninfected were modeled as populations, stratified by risk and gender. The model included detailed individual-level data from several large national surveillance databases. The outcomes focused on average annual transmission rates from 2008 through 2011 by disease stage, HIV care continuum, and sexual risk group.
The relative risk of transmission of those in the acute phase was nine-times [5 and 95 percentile simulation interval (SI): 7, 12] that of those in the non-acute phase, although, on average, those with acute infections comprised 1% of all PLWH. The relative risk of transmission was 24- to 50-times as high for those in the non-acute phase who had not achieved viral load suppression as compared with those who had. The relative risk of transmission among MSM was 3.2-times [SI: 2.7, 4.0] that of heterosexuals. Men who have sex with men and women generated 46% of sexually acquired transmissions among heterosexuals.
The model results support a continued focus on early diagnosis, treatment and adherence to ART, with an emphasis on prevention efforts for MSM, a subgroup of whom appear to play a role in transmission to heterosexuals.
HIV传播是风险行为、性伴选择、疾病阶段以及在HIV照护连续过程中所处位置等复杂动态变化的结果，而这些个体特征本身会随时间改变。捕捉这些动态变化并模拟传播情况以了解主要传播源对于预防工作仍然至关重要。
HIV/AIDS的进展与传播（PATH 2.0）是一个基于主体的模型，以10000名HIV感染者（PLWH）为样本，这些样本代表了美国所有男男性行为者（MSM）和感染HIV的异性恋者。未感染人群被建模为按风险和性别分层的群体。该模型纳入了来自几个大型国家监测数据库的详细个体层面数据。结果聚焦于2008年至2011年按疾病阶段、HIV照护连续过程和性风险群体划分的年均传播率。
急性期感染者的传播相对风险是非急性期感染者的9倍[5%和95%百分位数模拟区间（SI）：7，12]，不过，平均而言，急性感染患者仅占所有PLWH的1%。与病毒载量得到抑制的非急性期感染者相比，病毒载量未得到抑制的感染者的传播相对风险要高24至50倍。MSM中的传播相对风险是异性恋者的3.2倍[SI：2.7，4.0]。男男性行为者和女性在异性恋者性传播感染中占46%。
模型结果支持持续关注早期诊断、治疗及抗逆转录病毒治疗的依从性，尤其要重视针对MSM的预防工作，因为其中一部分人似乎在向异性恋者传播方面起到了作用。
