Gorbach Pamina M, Javanbakht Marjan, Bornfleth Lorelei, Bolan Robert K, Lewis Blum Martha
Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, United States of America.
Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States of America.
PLoS One. 2017 Mar 23;12(3):e0173892. doi: 10.1371/journal.pone.0173892. eCollection 2017.
Epidemiology of drug resistant HIV has focused on trends and less attention has been given to identification of factors, especially behaviors including substance use, in acquisition of drug-resistant HIV. From 2009 to 2012 The Metromates Study enrolled and followed for one year men who have sex with men (MSM) seeking testing for HIV in a community clinic in Los Angeles assessing those testing positive for acute and recent HIV infection. Behavioral data were collected via Computer-Assisted Self-Interview from 125 classified as newly HIV infected and 91 as chronically infected (newly HIV-diagnosed); specimens were available and viable for resistance testing for 154 of the 216 HIV positives with new diagnoses. In this community clinic we found prevalence of resistance among MSM with new HIV-diagnosis was 19.5% (n = 30/154) with no difference by recency of HIV infection. Sexual partnership characteristics were associated with resistance; those who reported transgendered sex partners had a higher prevalence of resistance as compared to those who did not report transgendered sex partners (40% vs. 17%; p value = 0.04), while those who reported having a main partner had a lower prevalence of drug resistance (12% vs. 24%; p value = 0.07). In multivariable analyses adjusting for HIV recency and antiviral use, reporting a main partner decreased odds [adjusted odds ratio (AOR) 0.34; 95% confidence interval (CI) 0.13-0.87], reporting a transgendered partnered increased odds (AOR = 3.37; 95% CI 0.95-12.43); and being African American increased odds of drug resistance (AOR = 5.63, 95%CI 1.41-22.38). This suggests African American MSM and TG individuals in Los Angeles represent pockets of exceptional risk that will require special approaches to prevention and care to enhance their own health and reduce their likelihood to support transmission of drug resistance in the US.
耐药性艾滋病毒的流行病学主要关注趋势，而对于在获得耐药性艾滋病毒过程中确定因素，尤其是包括物质使用在内的行为，关注较少。2009年至2012年，“大都市伙伴研究”招募了在洛杉矶一家社区诊所寻求艾滋病毒检测的男男性行为者（MSM），并对其进行了为期一年的跟踪，评估那些急性和近期艾滋病毒感染检测呈阳性的人。通过计算机辅助自我访谈收集了125名被归类为新感染艾滋病毒者和91名慢性感染（新诊断为艾滋病毒）者的行为数据；在216名新诊断为艾滋病毒阳性者中，有154人的样本可用于耐药性检测且样本可用。在这家社区诊所，我们发现新诊断为艾滋病毒的男男性行为者中耐药性的患病率为19.5%（n = 30/154），艾滋病毒感染近期情况对此无差异。性伴侣特征与耐药性有关；报告有变性性伴侣的人相比未报告有变性性伴侣的人耐药性患病率更高（40%对17%；p值 = 0.04），而报告有主要伴侣的人耐药性患病率较低（12%对24%；p值 = 0.07）。在对艾滋病毒近期情况和抗病毒药物使用进行调整的多变量分析中，报告有主要伴侣降低了几率[调整后的优势比（AOR）0.34；95%置信区间（CI）0.13 - 0.87]，报告有变性伴侣增加了几率（AOR = 3.37；95%CI 0.95 - 12.43）；非裔美国人耐药性几率增加（AOR = 5.63，95%CI 1.41 - 22.38）。这表明洛杉矶的非裔美国男男性行为者和变性者代表了特殊风险群体，需要采取特殊的预防和护理方法来增进他们自身的健康，并降低他们在美国支持耐药性传播的可能性。
