利用纵向遗传网络研究理解 HIV 治疗即预防。

Using longitudinal genetic-network study to understand HIV treatment-as-prevention.

机构信息

Department of Disease Prevention and Control, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou.

State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing.

出版信息

AIDS. 2021 May 1;35(6):947-955. doi: 10.1097/QAD.0000000000002812.

DOI:10.1097/QAD.0000000000002812

PMID:33443369

Abstract

OBJECTIVE

The WHO has recommended that antiretroviral therapy be provided to all HIV patients to reduce future HIV transmission rates. However, few studies have examined this public health strategy at the population level in a real-world setting.

METHODS

In this longitudinal genetic-network study in Guangxi, China, the baseline and follow-up data were collected from HIV patients in 2014 and newly diagnosed HIV patients from 2015 to 2018, respectively. The prevention efficacy was used to estimate the effect of treatment-as-prevention in reducing HIV secondary transmission.

RESULTS

Among 804 newly diagnosed HIV patients during 2015-2018, 399 (49.6%) of them genetically linked to HIV patients at baseline during 2014-2017. The overall proportion of genetic linkage between newly diagnosed HIV patients during 2015-2018 with untreated and treated HIV patients at baseline during 2014-2017 was 6.2 and 2.9%, respectively. The prevention efficacy in HIV transmission for treated HIV patients was 53.6% [95% confidence interval (95% CI): 42.1-65.1]. Subgroup analyses indicated an 80.3% (95% CI: 74.8-85.8) reduction in HIV transmission among HIV patients who were treated for 4 years or more and had viral loads less than 50 copies/ml. There was no significant reduction in HIV transmission among treated HIV patients who dropped out or who had missing viral load measures.

CONCLUSION

Our study results support the feasibility of treating all HIV patients for future reductions in HIV transmission at the population level in real-world settings. Comprehensive intervention prevention programmes are urgently needed.

摘要

目的

世界卫生组织（WHO）建议为所有 HIV 患者提供抗逆转录病毒治疗，以降低未来的 HIV 传播率。然而，很少有研究在真实环境下从人群层面上评估这一公共卫生策略。

方法

本项在中国广西开展的纵向遗传网络研究中，分别于 2014 年采集基线数据，于 2015 年至 2018 年采集随访数据，纳入新诊断的 HIV 患者。使用预防效果来估计治疗即预防在降低 HIV 二次传播中的作用。

结果

在 2015 年至 2018 年期间诊断的 804 名新诊断 HIV 患者中，有 399 名（49.6%）与 2014 年至 2017 年期间基线的 HIV 患者存在基因关联。在 2015 年至 2018 年期间诊断的新诊断 HIV 患者与 2014 年至 2017 年期间基线的未治疗和治疗 HIV 患者之间的总体基因关联比例分别为 6.2%和 2.9%。治疗 HIV 患者的 HIV 传播预防效果为 53.6%（95%置信区间：42.1%-65.1%）。亚组分析表明，对于治疗时间超过 4 年且病毒载量低于 50 拷贝/ml 的 HIV 患者，HIV 传播的降低率为 80.3%（95%置信区间：74.8%-85.8%）。而对于治疗中脱落或未进行病毒载量检测的 HIV 患者，HIV 传播的降低效果并不显著。