描述美国接受治疗的 HIV 感染者的 HIV 传播风险：一项对病毒载量超过 1500 拷贝/毫升的个体的性行为风险行为的横断面研究。
Characterising HIV transmission risk among US patients with HIV in care: a cross-sectional study of sexual risk behaviour among individuals with viral load above 1500 copies/mL.
机构信息
Division of AIDS Research, National Institute of Mental Health, Bethesda, Maryland, USA.
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
出版信息
Sex Transm Infect. 2018 May;94(3):206-211. doi: 10.1136/sextrans-2017-053178. Epub 2017 Nov 2.
OBJECTIVES
Viral load and sexual risk behaviour contribute to HIV transmission risk. High HIV viral loads present greater transmission risk than transient viral 'blips' above an undetectable level. This paper therefore characterises sexual risk behaviour among patients with HIV in care with viral loads>1500 copies/mL and associated demographic characteristics.
METHODS
This cross-sectional study was conducted at six HIV outpatient clinics in USA. The study sample comprises 1315 patients with HIV with a recent viral load >1500 copies/mL. This study sample was drawn from a larger sample of individuals with a recent viral load >1000 copies/mL who completed a computer-assisted self-interview (CASI) regarding sexual risk practices in the last 2 months. The study sample was 32% heterosexual men, 38% men who have sex with men (MSM) and 30% women.
RESULTS
Ninety per cent of the sample had their viral load assay within 60 days of the CASI. Thirty-seven per cent reported being sexually active (vaginal or anal intercourse) in the last 2 months. Most of the sexually active participants reported always using condoms (56.9%) or limiting condomless sex to seroconcordant partners (serosorting; 29.2% overall and 42.9% among MSM). Among sexually active participants who reported condomless anal or vaginal sex with an at-risk partner (14%), most had viral loads>10 000 copies/mL (62%).
CONCLUSIONS
A relatively small number of patients with HIV in care with viral loads above 1500 copies/mL reported concurrent sexual transmission risk behaviours. Most of the individuals in this small group had markedly elevated viral loads, increasing the probability of transmission. Directing interventions to patients in care with high viral loads and concurrent risk behaviour could strengthen HIV prevention and reduce HIV infections.
TRIAL REGISTRATION NUMBER
NCT02044484, completed.
目的
病毒载量和性行为风险是导致 HIV 传播的因素。高于检测下限的高病毒载量比短暂的“病毒突增”具有更大的传播风险。因此，本文描述了 HIV 感染者接受治疗时病毒载量＞1500 拷贝/ml 时的性行为风险，并分析了与之相关的人口统计学特征。
方法
本横断面研究在美国六家 HIV 门诊诊所进行。研究样本包括 1315 名 HIV 患者，他们的最近一次病毒载量＞1500 拷贝/ml。本研究样本来自更大的最近病毒载量＞1000 拷贝/ml 的个体样本，这些个体完成了关于过去 2 个月性行为风险的计算机辅助自我访谈（CASI）。研究样本中，32%为异性恋男性，38%为男男性行为者（MSM），30%为女性。
结果
90%的样本在 CASI 后 60 天内进行了病毒载量检测。37%的人报告在过去 2 个月内有过性行为（阴道或肛门性交）。大多数有过性行为的参与者报告总是使用避孕套（56.9%）或仅与血清学一致的伴侣发生无保护性行为（血清学选择；总体 29.2%，MSM 中 42.9%）。在报告与高危伴侣发生无保护肛交或阴道交的有性行为的参与者中（14%），大多数病毒载量＞10000 拷贝/ml（62%）。
结论
在接受治疗且病毒载量高于 1500 拷贝/ml 的 HIV 感染者中，只有相对较少的人报告存在同时发生的性传播风险行为。在这个小群体中，大多数人具有明显升高的病毒载量，增加了传播的可能性。针对高病毒载量且存在并发风险行为的患者开展干预措施，可能会加强 HIV 预防并减少 HIV 感染。
试验注册号
NCT02044484，已完成。
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