大规模聚集性疫情在魁北克省男男性行为者中持续推动着艾滋病病毒的传播。

Large cluster outbreaks sustain the HIV epidemic among MSM in Quebec.

作者信息

Brenner Bluma G, Ibanescu Ruxandra-Ilinca, Hardy Isabelle, Stephens David, Otis Joanne, Moodie Erica, Grossman Zehava, Vandamme Anne-Mieke, Roger Michel, Wainberg Mark A

机构信息

aMcGill AIDS Centre, Lady Davis Institute for Medical Research bDépartement de Microbiologie et d'Immunologie et Centre de Recherche du Centre hospitalier de l'Université de Montréal (CHUM) cDepartment of Mathematics and Statistics, Biostatistics and Occupational Health, McGill University dUniversité du Québec eDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada fTel Aviv University, Tel Aviv, Israel gDepartment of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven - University of Leuven, Leuven, Belgium hCenter for Global Health and Tropical Medicine, Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal.

出版信息

AIDS. 2017 Mar 13;31(5):707-717. doi: 10.1097/QAD.0000000000001383.

DOI:10.1097/QAD.0000000000001383

PMID:28005684

Abstract

OBJECTIVE

HIV-1 epidemics among MSM remain unchecked despite advances in treatment and prevention paradigms. This study combined viral phylogenetic and behavioural risk data to better understand underlying factors governing the temporal growth of the HIV epidemic among MSM in Quebec (2002-2015).

METHODS

Phylogenetic analysis of pol sequences was used to deduce HIV-1 transmission dynamics (cluster size, size distribution and growth rate) in first genotypes of treatment-naïve MSM (2002-2015, n = 3901). Low sequence diversity of first genotypes (0-0.44% mixed base calls) was used as an indication of early-stage infection. Behavioural risk data were obtained from the Montreal rapid testing site and primary HIV-1-infection cohorts.

RESULTS

Phylogenetic analyses uncovered high proportion of clustering of new MSM infections. Overall, 27, 45, 48, 53 and 57% of first genotypes within one (singleton, n = 1359), 2-4 (n = 692), 5-9 (n = 367), 10-19 (n = 405) and 20+ (n = 1277) cluster size groups were early infections (<0.44% diversity). Thirty viruses within large 20+ clusters disproportionately fuelled the epidemic, representing 13, 25 and 42% of infections, first genotyped in 2004-2007 (n = 1314), 2008-2011 (n = 1356) and 2012-2015 (n = 1033), respectively. Of note, 35, 21 and 14% of MSM belonging to 20+, 2-19 and one (singleton) cluster groups were under 30 years of age, respectively. Half of persons seen at the rapid testing site (2009-2011, n = 1781) were untested in the prior year. Poor testing propensity was associated with fewer reported partnerships.

CONCLUSION

Addressing the heterogeneity in transmission dynamics among HIV-1-infected MSM populations may help guide testing, treatment and prevention strategies.

摘要

目的

尽管在治疗和预防模式方面取得了进展，但男男性行为者（MSM）中的HIV-1流行仍未得到控制。本研究结合病毒系统发育和行为风险数据，以更好地了解魁北克省MSM中HIV流行的时间增长的潜在因素（2002 - 2015年）。

方法

对初治MSM的首个基因型（2002 - 2015年，n = 3901）的pol序列进行系统发育分析，以推断HIV-1传播动态（簇大小、大小分布和增长率）。首个基因型的低序列多样性（0 - 0.44%混合碱基调用）被用作早期感染的指标。行为风险数据来自蒙特利尔快速检测点和原发性HIV-1感染队列。

结果

系统发育分析发现新的MSM感染聚类比例很高。总体而言，在簇大小为1（单例，n = 1359）、2 - 4（n = 692）、5 - 9（n = 367）、10 - 19（n = 405）和20 +（n = 1277）的组中，分别有27%、45%、48%、53%和57%的首个基因型为早期感染（多样性<0.44%）。20 +大簇中的30种病毒不成比例地推动了疫情，分别占2004 - 2007年（n = 1314）、2008 - 2011年（n = 1356）和2012 - 2015年（n = 1033）首次基因分型感染的13%、25%和42%。值得注意的是，分别有35%、21%和14%属于20 +、2 - 19和1（单例）簇组的MSM年龄在30岁以下。在快速检测点就诊的人中（2009 - 2011年，n = 1781），一半在前一年未进行检测。检测倾向低与报告的性伴侣较少有关。