印度关键人群中可检测到的 HIV 病毒血症的人群水平流行率的时间变化及其与 HIV 发病率的关系：一项连续的横断面研究。
Temporal change in population-level prevalence of detectable HIV viraemia and its association with HIV incidence in key populations in India: a serial cross-sectional study.
机构信息
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Lancet HIV. 2021 Sep;8(9):e544-e553. doi: 10.1016/S2352-3018(21)00098-9. Epub 2021 Jul 28.
BACKGROUND
Population-level prevalence of detectable HIV viraemia (PDV) has been proposed as a metric for monitoring the population-level effectiveness of HIV treatment as prevention. We aimed to characterise temporal changes in PDV in people who inject drugs (PWID) and men who have sex with men (MSM) in India and evaluate community-level and individual-level associations with cross-sectional HIV incidence.
METHODS
We did a serial cross-sectional study in which baseline (from Oct 1, 2012, to Dec 19, 2013) and follow-up (from Aug 1, 2016, to May 28, 2017) respondent-driven sampling (RDS) surveys were done in MSM (ten community sites) and PWID (12 community sites) across 21 cities in India. Eligible participants were those aged 18 years or older who provided informed consent and possessed a valid RDS referral coupon. Annualised HIV incidence was estimated with validated multiple-assay algorithms. PDV was calculated as the percentage of people with detectable HIV RNA (>150 copies per mL) in a community site. Community-level associations were determined by linear regression. Multivariable, multilevel Poisson regression was used to assess associations with recent HIV infection.
FINDINGS
We recruited 21 990 individuals in the baseline survey and 21 726 individuals in the follow-up survey. The median community-level HIV incidence estimate increased from 0·9% (range 0·0-2·2) at baseline to 1·5% (0·5-3·0) at follow-up in MSM and from 1·6% (0·5-12·4) to 3·6% (0·0-18·4) in PWID. At the community-level, every 1 percentage point increase in baseline PDV and temporal change in PDV between surveys was associated with higher annualised HIV incidence at follow-up: for baseline PDV β=0·41 (95% CI 0·18-0·63) and for change in PDV β=0·52 (0·38-0·66). After accounting for individual-level risk factors, every 10 percentage point increase in baseline PDV and temporal change in PDV was associated with higher individual-level risk of recent HIV infection at follow-up: adjusted risk ratio 1·85 (95% CI 1·44-2·37) for baseline PDV and 1·81 (1·43-2·29) for change in PDV.
INTERPRETATION
PDV was temporally associated with community-level and individual-level HIV incidence. These data support scale-up of treatment as prevention programmes to reduce HIV incidence and the programmatic use of PDV to monitor community HIV risk potential.
FUNDING
US National Institutes of Health, Elton John AIDS Foundation.
背景
人群中可检测到的 HIV 病毒血症（PDV）的流行率已被提议作为监测 HIV 治疗作为预防的人群效果的指标。我们旨在描述印度注射毒品者（PWID）和男男性接触者（MSM）中 PDV 的时间变化，并评估其与横断面 HIV 发病率的社区和个体水平的相关性。
方法
我们进行了一项连续的横断面研究，在印度 21 个城市的 MSM（10 个社区地点）和 PWID（12 个社区地点）中，于 2012 年 10 月 1 日至 2013 年 12 月 19 日进行了基线（回顾性）调查，于 2016 年 8 月 1 日至 2017 年 5 月 28 日进行了随访（前瞻性）调查。符合条件的参与者为年龄在 18 岁及以上，同意并拥有有效 RDS 转介券的人群。使用经过验证的多重检测算法估计了年化 HIV 发病率。PDV 计算为社区地点中具有可检测 HIV RNA（>150 拷贝/毫升）的人数的百分比。通过线性回归确定社区水平的相关性。使用多变量、多层次泊松回归来评估与近期 HIV 感染的相关性。
结果
我们在基线调查中招募了 21990 人，在随访调查中招募了 21726 人。MSM 中社区水平 HIV 发病率估计中位数从基线时的 0.9%（范围 0.0-2.2）增加到随访时的 1.5%（0.5-3.0），PWID 中从 1.6%（0.5-12.4）增加到 3.6%（0.0-18.4）。在社区层面，基线 PDV 每增加 1 个百分点和两次调查之间 PDV 的时间变化与随访时的年化 HIV 发病率升高相关：基线 PDV 的β值为 0.41（95%CI 0.18-0.63），PDV 的时间变化β值为 0.52（0.38-0.66）。在考虑了个体水平的风险因素后，基线 PDV 和 PDV 时间变化每增加 10 个百分点与随访时个体 HIV 近期感染的风险增加相关：基线 PDV 的调整风险比为 1.85（95%CI 1.44-2.37），PDV 时间变化的调整风险比为 1.81（1.43-2.29）。
结论
PDV 与社区和个体 HIV 发病率呈时间相关性。这些数据支持扩大治疗作为预防计划，以降低 HIV 发病率，并支持将 PDV 用于监测社区 HIV 风险潜力。
资助
美国国立卫生研究院，Elton John AIDS 基金会。
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