HIV-1 疫苗接种后的风险补偿可能加速病毒适应并降低成本效益:一项建模研究。
Risk compensation after HIV-1 vaccination may accelerate viral adaptation and reduce cost-effectiveness: a modeling study.
机构信息
Department of Epidemiology, University of Washington, Seattle, WA, USA.
Department of Microbiology, University of Washington, Seattle, WA, USA.
出版信息
Sci Rep. 2021 Mar 24;11(1):6798. doi: 10.1038/s41598-021-85487-w.
Pathogen populations can evolve in response to selective pressure from vaccine-induced immune responses. For HIV, models predict that viral adaptation, either via strain replacement or selection on de novo mutation, may rapidly reduce the effectiveness of an HIV vaccine. We hypothesized that behavioral risk compensation after vaccination may accelerate the transmission of vaccine resistant strains, increasing the rate of viral adaptation and leading to a more rapid decline in vaccine effectiveness. To test our hypothesis, we modeled: (a) the impact of risk compensation on rates of HIV adaptation via strain replacement in response to a partially effective vaccine; and (b) the combined impact of risk compensation and viral adaptation on vaccine-mediated epidemic control. We used an agent-based epidemic model that was calibrated to HIV-1 trends in South Africa, and includes demographics, sexual network structure and behavior, and within-host disease dynamics. Our model predicts that risk compensation can increase the rate of HIV viral adaptation in response to a vaccine. In combination, risk compensation and viral adaptation can, under certain scenarios, reverse initial declines in prevalence due to vaccination, and result in HIV prevalence at 15 years equal to or greater than prevalence without a vaccine.
病原体种群可以通过疫苗诱导的免疫反应产生的选择压力来进化。对于 HIV 来说,模型预测,病毒的适应性可能会通过毒株替换或新突变的选择,迅速降低 HIV 疫苗的有效性。我们假设,接种疫苗后的行为风险补偿可能会加速疫苗耐药毒株的传播,增加病毒适应性的速度,并导致疫苗有效性更快地下降。为了检验我们的假设,我们建立了模型:(a) 风险补偿对部分有效疫苗引起的毒株替换的 HIV 适应性的影响;以及 (b) 风险补偿和病毒适应性对疫苗介导的疫情控制的综合影响。我们使用了一种基于代理的传染病模型,该模型经过校准,可以反映南非的 HIV-1 趋势,包括人口统计学、性网络结构和行为以及宿主内疾病动态。我们的模型预测,风险补偿可以增加疫苗接种后 HIV 病毒适应性的速度。在某些情况下,风险补偿和病毒适应性的结合可能会逆转由于疫苗接种而导致的最初流行率下降,并导致 15 年后 HIV 的流行率等于或高于没有疫苗的流行率。