佛蒙特州发现 1 型人类免疫缺陷病毒和神经梅毒聚集病例。

Identification of a Human Immunodeficiency Virus Type 1 and Neurosyphilis Cluster in Vermont.

机构信息

Division of Infectious Disease, Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA.

Department of Pediatrics, Larner College of Medicine, Burlington, Vermont, USA.

出版信息

Clin Infect Dis. 2021 Nov 2;73(9):e3244-e3249. doi: 10.1093/cid/ciaa1834.

DOI:10.1093/cid/ciaa1834

PMID:33289032

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11318571/

Abstract

BACKGROUND

Rates of syphilis in the United States have more than doubled over the last several decades, largely among men who have sex with men (MSM). Our study characterizes a cluster of neurosyphilis cases among people with human immunodeficiency virus 1 (HIV-1) in Vermont in 2017-2018.

METHODS

Vermont Department of Health disease intervention specialists conduct interviews with newly diagnosed HIV-1 cases and pursue sexual networking analyses. Phylogenetic and network analyses of available Vermont HIV-1 polymerase (pol) sequences identified clusters of infection. Fishers-exact and independent t-tests were used to compare people with HIV-1 within or outside an identified cluster.

RESULTS

Between 1 January 2017 and 31 December 2018, 38 residents were diagnosed with HIV-1 infection. The mean age was 35.5 years, 79% were male and 82% were White. Risk factors for HIV-1 included MSM status (79%) and methamphetamine use (21%). Eighteen cases (49%) had HIV-1 viral loads (VLs) >100 000 copies/mL and 47% had CD4 cell counts <200/mm3. Eleven of the 38 (29%) had positive syphilis serology, including four (36%) with neurosyphilis. Sexual networking analysis revealed a ten-person cluster with higher VLs at diagnosis (90% with VLs > 100 000 copies/mL vs 33%, P = 0.015). Phylogenetic analysis of pol sequences showed a cluster of 14 cases with sequences that shared 98%-100% HIV-1 nucleotide identity.

CONCLUSIONS

This investigation of newly infected HIV-1 cases in Vermont led to identification of a cluster that appeared more likely to have advanced HIV-1 disease and neurosyphilis, supported by phylogenetic and network analyses.

摘要

背景

美国梅毒发病率在过去几十年中增加了一倍多，主要发生在男男性行为者（MSM）中。我们的研究描述了 2017-2018 年佛蒙特州 1 例人类免疫缺陷病毒 1（HIV-1）感染者神经梅毒病例。

方法

佛蒙特州卫生署疾病干预专家对新诊断的 HIV-1 病例进行访谈，并进行性网络分析。对现有佛蒙特州 HIV-1 聚合酶（pol）序列进行系统发育和网络分析，确定感染群。Fisher 精确检验和独立 t 检验用于比较感染群内和感染群外的 HIV-1 感染者。

结果

2017 年 1 月 1 日至 2018 年 12 月 31 日期间，38 名居民被诊断为 HIV-1 感染。平均年龄为 35.5 岁，79%为男性，82%为白人。HIV-1 感染的危险因素包括 MSM 身份（79%）和使用冰毒（21%）。18 例（49%）HIV-1 病毒载量（VL）>100000 拷贝/ml，47%的 CD4 细胞计数<200/mm3。38 例中有 11 例（29%）梅毒血清学阳性，包括 4 例（36%）神经梅毒。性网络分析显示有一个 10 人的感染群，该感染群在诊断时的 VL 更高（90%的 VL>100000 拷贝/ml 与 33%，P=0.015）。pol 序列的系统发育分析显示，有一个由 14 例病例组成的感染群，这些病例的 HIV-1 核苷酸序列具有 98%-100%的同源性。