治疗即预防时代下 HIV 伴侣服务的效用：基于注册的研究。

HIV Epidemiology Program, Bureau of HIV, New York City Department of Health and Mental Hygiene, New York, NY, USA.

Lancet HIV. 2020 Jul;7(7):e482-e490. doi: 10.1016/S2352-3018(20)30116-8.

BACKGROUND

Partner services are effective tools to identify new cases among sex or needle-sharing partners of people with a new HIV diagnosis. Little is known about partners previously diagnosed with HIV who are not in care or are in care with unsuppressed HIV viral load. We aimed to quantify the previously diagnosed partners of people with a new HIV infection and examine their HIV care status and viral suppression in the 12 months before elicitation.

METHODS

We did a registry-based study. We used the New York City HIV Surveillance Registry to determine HIV care status and viral load of partners elicited from newly diagnosed people between Jan 1, 2007, and Dec 31, 2018. Previously diagnosed partners with no report of CD4 count or viral load in the preceding 12 months were presumed not to be in care, viral load suppression (<200 copies per mL) was based on the last viral load in the year preceding elicitation, and viraemia was defined as a viral load of 200 copies per mL or more. We used multinomial logistic regression to generate covariates of care and viral load status and their marginal effects.

FINDINGS

11 964 partners were elicited; 2603 (33%) were previously diagnosed and 485 (20%) were not in care. 1153 (49%) of 2343 with a viral load report were in care and viraemic at elicitation. The odds of being not in care were higher in non-Hispanic black than non-Hispanic white or other partners (adjusted odds ratio 1·89, 95% CI 1·09-3·27) and lower in partners with male-to-male sex transmission risk (0·37, 0·26-0·51) and country of birth other than the USA (0·57, 0·39-0·85). The odds of being viraemic were higher in partners younger than 30 years than in those aged 30 years or older (1·68, 1·35-2·09) and lower among people with male-to-male sex transmission risk (0·36, 0·29-0·44) and country of birth other than the USA (0·78, 0·66-0·97).

INTERPRETATION

People with HIV should receive ongoing HIV prevention counselling and partner services data should inform engagement in care for previously diagnosed partners.

FUNDING

None.

背景

伙伴服务是识别新诊断出 HIV 感染者的性伴侣或共用针具伙伴中新病例的有效工具。对于未接受治疗或正在接受治疗但 HIV 病毒载量未得到抑制的 HIV 既往诊断伙伴知之甚少。我们旨在量化新感染 HIV 的人群中既往诊断的伙伴，并在招募前的 12 个月内检查他们的 HIV 治疗状况和病毒抑制情况。

方法

我们进行了一项基于登记的研究。我们使用纽约市 HIV 监测登记处确定了 2007 年 1 月 1 日至 2018 年 12 月 31 日期间从新诊断的患者中招募的伙伴的 HIV 治疗状况和病毒载量。在过去 12 个月内未报告 CD4 计数或病毒载量的既往诊断伙伴被认为未接受治疗，病毒载量抑制（<200 拷贝/毫升）基于前一年招募前的最后一次病毒载量，病毒血症定义为病毒载量为 200 拷贝/毫升或更高。我们使用多项逻辑回归生成治疗和病毒载量状况的协变量及其边际效应。

结果

共招募了 11964 名伙伴，其中 2603 名（33%）为既往诊断，485 名（20%）未接受治疗。在有病毒载量报告的 2343 名中，有 1153 名（49%）接受治疗，且在招募时病毒血症。与非西班牙裔白人或其他伙伴相比，非西班牙裔黑人（调整后的优势比 1.89，95%CI 1.09-3.27）和具有男男性行为传播风险（0.37，0.26-0.51）以及出生国非美国（0.57，0.39-0.85）的伙伴未接受治疗的可能性更高。与 30 岁或以上的伙伴相比，年龄在 30 岁以下的伙伴发生病毒血症的可能性更高（1.68，1.35-2.09），具有男男性行为传播风险（0.36，0.29-0.44）和出生国非美国（0.78，0.66-0.97）的伙伴发生病毒血症的可能性更低。