Hakre Shilpa, Jagodzinski Linda L, Liu Ying, Pham Peter T, Kijak Gustavo H, Tovanabutra Sodsai, McCutchan Francine E, Scoville Stephanie L, Cersovsky Steven B, Michael Nelson L, Scott Paul T, Peel Sheila A
U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America.
PLoS One. 2017 Jul 31;12(7):e0182376. doi: 10.1371/journal.pone.0182376. eCollection 2017.
Recent surveillance data suggests the United States (U.S.) Army HIV epidemic is concentrated among men who have sex with men. To identify potential targets for HIV prevention strategies, the relationship between demographic and clinical factors and membership within transmission clusters based on baseline pol sequences of HIV-infected Soldiers from 2001 through 2012 were analyzed.
We conducted a retrospective analysis of baseline partial pol sequences, demographic and clinical characteristics available for all Soldiers in active service and newly-diagnosed with HIV-1 infection from January 1, 2001 through December 31, 2012. HIV-1 subtype designations and transmission clusters were identified from phylogenetic analysis of sequences. Univariate and multivariate logistic regression models were used to evaluate and adjust for the association between characteristics and cluster membership.
Among 518 of 995 HIV-infected Soldiers with available partial pol sequences, 29% were members of a transmission cluster. Assignment to a southern U.S. region at diagnosis and year of diagnosis were independently associated with cluster membership after adjustment for other significant characteristics (p<0.10) of age, race, year of diagnosis, region of duty assignment, sexually transmitted infections, last negative HIV test, antiretroviral therapy, and transmitted drug resistance. Subtyping of the pol fragment indicated HIV-1 subtype B infection predominated (94%) among HIV-infected Soldiers.
These findings identify areas to explore as HIV prevention targets in the U.S. Army. An increased frequency of current force testing may be justified, especially among Soldiers assigned to duty in installations with high local HIV prevalence such as southern U.S. states.
近期监测数据表明，美国陆军的艾滋病病毒疫情集中在男男性行为者中。为确定艾滋病病毒预防策略的潜在目标，分析了2001年至2012年期间感染艾滋病病毒的士兵的人口统计学和临床因素与基于基线pol序列的传播集群成员身份之间的关系。
我们对2001年1月1日至2012年12月31日期间现役且新诊断为HIV-1感染的所有士兵的基线部分pol序列、人口统计学和临床特征进行了回顾性分析。通过序列的系统发育分析确定HIV-1亚型分类和传播集群。使用单变量和多变量逻辑回归模型来评估和调整特征与集群成员身份之间的关联。
在995名有可用部分pol序列的感染艾滋病病毒的士兵中，518名（29%）是传播集群的成员。在对年龄、种族、诊断年份、任务分配地区、性传播感染、最后一次HIV检测阴性、抗逆转录病毒治疗和传播的耐药性等其他重要特征进行调整后，诊断时被分配到美国南部地区以及诊断年份与集群成员身份独立相关（p<0.10）。pol片段的亚型分析表明，感染艾滋病病毒的士兵中以HIV-1 B亚型感染为主（94%）。
这些发现确定了美国陆军中可作为艾滋病病毒预防目标进行探索的领域。增加当前部队检测的频率可能是合理的，特别是在分配到当地艾滋病病毒流行率高的设施（如美国南部各州）执行任务的士兵中。
