美国男男性行为者中的 HIV 发病率、流行率和未诊断感染。

HIV Incidence, Prevalence, and Undiagnosed Infections in U.S. Men Who Have Sex With Men.

机构信息

Centers for Disease Control and Prevention, Atlanta, Georgia (S.S., R.S., A.S.J., E.M., H.I.H.).

出版信息

Ann Intern Med. 2018 May 15;168(10):685-694. doi: 10.7326/M17-2082. Epub 2018 Mar 20.

DOI:10.7326/M17-2082

PMID:29554663

Abstract

BACKGROUND

HIV infection is a persistent health concern in the United States, and men who have sex with men (MSM) continue to be the most affected population.

OBJECTIVE

To estimate HIV incidence and prevalence and the percentage of undiagnosed HIV infections overall and among MSM.

DESIGN

Cross-sectional analysis.

SETTING

National HIV Surveillance System.

PARTICIPANTS

Persons aged 13 years or older with diagnosed HIV infection.

MEASUREMENTS

Data on HIV diagnoses and the first CD4 test result after diagnosis were used to model HIV incidence and prevalence and the percentage of undiagnosed HIV infections from 2008 to 2015 on the basis of a well-characterized CD4 depletion model.

RESULTS

Modeled HIV incidence decreased 14.8% overall, from 45 200 infections in 2008 to 38 500 in 2015, and among all transmission risk groups except MSM. The incidence of HIV increased 3.1% (95% CI, 1.6% to 4.5%) per year among Hispanic/Latino MSM (6300 infections in 2008, 7900 in 2015), decreased 2.7% (CI, -3.8% to -1.5%) per year among white MSM (8800 infections in 2008, 7100 in 2015), and remained stable among black MSM at about 10 000 infections. The incidence decreased by 3.0% (CI, -4.2% to -1.8%) per year among MSM aged 13 to 24 years and by 4.7% (CI, -6.2% to -3.1%) per year among those aged 35 to 44 years. Among MSM aged 25 to 34 years, HIV incidence increased 5.7% (CI, 4.4% to 7.0%) per year and among MSM aged 55 years and older, HIV increased 4.1% (CI, 0.8% to 7.4%). The percentage of undiagnosed HIV infections was higher among black, Hispanic/Latino, and younger MSM than white and older MSM, respectively.

LIMITATION

Assumptions of the CD4 depletion model and variability of CD4 values.

CONCLUSION

Expansion of HIV screening to reduce undiagnosed infections and increased access to care and treatment to achieve viral suppression are critical to reduce HIV transmission. Access to prevention methods, such as condoms and preexposure prophylaxis, also is needed, particularly among MSM of color and young MSM.

PRIMARY FUNDING SOURCE

None.

摘要

背景

在美国，HIV 感染一直是一个持续存在的健康问题，男男性行为者（MSM）仍然是受影响最严重的人群。

目的

估计 HIV 的发病率、患病率以及总体和 MSM 中未确诊 HIV 感染的比例。

设计

横断面分析。

地点

国家 HIV 监测系统。

参与者

年龄在 13 岁及以上、已确诊 HIV 感染的人群。

测量方法

利用 HIV 诊断和诊断后首次 CD4 检测结果的数据，基于经过充分验证的 CD4 耗竭模型，对 2008 年至 2015 年期间 HIV 的发病率、患病率和未确诊 HIV 感染的比例进行建模。

结果

总体而言，HIV 发病率下降了 14.8%，从 2008 年的 45200 例下降到 2015 年的 38500 例，除 MSM 外，所有传播风险组的发病率均有所下降。西班牙裔/拉丁裔 MSM 的 HIV 发病率每年增加 3.1%（95%CI，1.6%至 4.5%）（2008 年为 6300 例感染，2015 年为 7900 例感染），白种 MSM 的发病率每年下降 2.7%（CI，-3.8%至-1.5%）（2008 年为 8800 例感染，2015 年为 7100 例感染），而黑种 MSM 的发病率保持稳定，约为 10000 例感染。年龄在 13 至 24 岁的 MSM 中，发病率每年下降 3.0%（CI，-4.2%至-1.8%），年龄在 35 至 44 岁的 MSM 中，发病率每年下降 4.7%（CI，-6.2%至-3.1%）。年龄在 25 至 34 岁的 MSM 中，HIV 发病率每年增加 5.7%（CI，4.4%至 7.0%），年龄在 55 岁及以上的 MSM 中，HIV 发病率每年增加 4.1%（CI，0.8%至 7.4%）。黑人、西班牙裔/拉丁裔和年轻的 MSM 中未确诊 HIV 感染的比例高于白人及年长的 MSM。