National Infection Service, Public Health England, Colindale Avenue, London, United Kingdom.
Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, United Kingdom.
PLoS One. 2018 Jun 20;13(6):e0197939. doi: 10.1371/journal.pone.0197939. eCollection 2018.
The HIV epidemic in England is largely concentrated among heterosexuals who are predominately black African and men who have sex with men (MSM). We present for the first time trends in annual HIV incidence for adults attending sexual health clinics, where 80% of all HIV diagnoses are made.
We identified newly diagnosed incident HIV using a recent infection testing algorithm (RITA) consisting of a biomarker (AxSYM assay, modified to determine antibody avidity), epidemiological and clinical information. We estimated HIV incidence using the WHO RITA formula for cross-sectional studies, with HIV testing data from sexual health clinics as the denominator.
From 2009 to 2013, each year, between 9,700 and 26,000 black African heterosexuals (of between 161,000 and 231,000 heterosexuals overall) were included in analyses. For the same period, annually between 19,000 and 55,000 MSM were included. Estimates of HIV incidence among black Africans increased slightly (although non-significantly) from 0.15% (95% C.I.0.05%-0.26%) in 2009 to 0.19% (95% C.I.0.04%-0.34%) in 2013 and was 4-5-fold higher than among all heterosexuals among which it remained stable between 0.03% (95% C.I.0.02%-0.05%) and 0.05% (95% C.I.0.03%-0.07%) over the period. Among MSM incidence was highest and increased (non-significantly) from 1.24% (95%C.I 0.96-1.52%) to 1.46% (95% C.I 1.23%-1.70%) after a peak of 1.52% (95%C.I 1.30%-1.75%) in 2012.
These are the first nationwide estimates for trends in HIV incidence among black African and heterosexual populations in England which show black Africans, alongside MSM, remain disproportionately at risk of infection. Although people attending sexual health clinics may not be representative of the general population, nearly half of black Africans and MSM had attended in the previous 5 years. Timely and accurate incidence estimates will be critical in monitoring the impact of the reconfiguration of sexual health services in England, and any prevention programmes such as pre-exposure prophylaxis.
英国的艾滋病毒疫情主要集中在异性恋者中，他们主要是非洲裔黑人，以及男男性接触者（MSM）。我们首次报告了性健康诊所就诊成年人的年度艾滋病毒发病率趋势，在这些诊所中，80%的艾滋病毒诊断都是这样做的。
我们使用最近感染检测算法（RITA）确定新诊断的艾滋病毒感染病例，该算法由生物标志物（AxSYM 检测，修改以确定抗体亲和力）、流行病学和临床信息组成。我们使用世界卫生组织 RITA 公式为横断面研究估算艾滋病毒发病率，将性健康诊所的艾滋病毒检测数据作为分母。
从 2009 年到 2013 年，每年有 9700 至 26000 名非洲裔黑人异性恋者（占总体 161000 至 231000 名异性恋者）被纳入分析。同期，每年有 19000 至 55000 名男男性接触者被纳入。在 2009 年至 2013 年期间，非洲裔黑人的艾滋病毒发病率略有上升（尽管无统计学意义），从 0.15%（95%CI0.05%-0.26%）上升至 0.19%（95%CI0.04%-0.34%），而所有异性恋者的发病率则稳定在 0.03%（95%CI0.02%-0.05%）和 0.05%（95%CI0.03%-0.07%）之间。在男男性接触者中，发病率最高且呈上升趋势（无统计学意义），从 1.24%（95%C.I 0.96-1.52%）上升至 1.46%（95% C.I 1.23%-1.70%），在 2012 年达到 1.52%（95%C.I 1.30%-1.75%）的峰值后略有上升。
这是首次在全国范围内对英格兰非洲裔黑人和异性恋人群艾滋病毒发病率趋势进行的估计，结果表明，非洲裔黑人以及男男性接触者仍然面临不成比例的感染风险。尽管在性健康诊所就诊的人群可能不能代表一般人群，但近一半的非洲裔黑人和男男性接触者在过去 5 年中曾就诊过。及时、准确的发病率估计将对监测英格兰性健康服务重组的影响以及任何预防计划（如暴露前预防）至关重要。
