Chen Jin, Chen Huanhuan, Li Jianjun, Luo Liuhong, Kang Ruihua, Liang Shujia, Zhu Qiuying, Lu Huaxiang, Zhu Jinhui, Shen Zhiyong, Feng Yi, Liao Lingjie, Xing Hui, Shao Yiming, Ruan Yuhua, Lan Guanghua
State Key Laboratory of Infectious Disease Prevention and Control, National Center for Acquired Immune Deficiency Syndrome (AIDS)/Sexually Transmitted Disease (STD) Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China.
Front Microbiol. 2022 Aug 18;13:962477. doi: 10.3389/fmicb.2022.962477. eCollection 2022.
This study is used to analyze the genetic network of HIV sexual transmission in rural areas of Southwest China after expanding antiretroviral therapy (ART) and to investigate the factors associated with HIV sexual transmission through the genetic network.
This was a longitudinal genetic network study in Guangxi, China. The baseline survey and follow-up study were conducted among patients with HIV in 2015, and among those newly diagnosed from 2016 to 2018, respectively. A generalized estimating equation model was employed to explore the factors associated with HIV transmission through the genetic linkage between newly diagnosed patients with HIV (2016-2018) and those at baseline (2015-2017), respectively.
Of 3,259 identified HIV patient sequences, 2,714 patients were at baseline, and 545 were newly diagnosed patients with HIV at follow-up. A total of 8,691 baseline objectives were observed by repeated measurement analysis. The prevention efficacy in HIV transmission for treated HIV patients was 33% [adjusted odds ratio (AOR): 0.67, 95% confidence interval (CI): 0.48-0.93]. Stratified analyses indicated the prevention efficacy in HIV transmission for treated HIV patients with a viral load (VL) of <50 copies/ml and those treated for 4 years with a VL of <50 copies/ml to be 41 [AOR: 0.59, 95% CI: 0.43-0.82] and 65% [AOR: 0.35, 95% CI: 0.24-0.50], respectively. No significant reduction in HIV transmission occurred among treated HIV patients with VL missing or treated HIV patients on dropout. Some factors were associated with HIV transmission, including over 50 years old, men, Zhuang and other nationalities, with less than secondary schooling, working as a farmer, and heterosexual transmission.
This study reveals the role of ART in reducing HIV transmission, and those older male farmers with less than secondary schooling are at high risk of HIV infection at a population level. Improvements to ART efficacy for patients with HIV and precision intervention on high-risk individuals during the expansion of ART are urgently required.
本研究旨在分析中国西南部农村地区扩大抗逆转录病毒治疗（ART）后HIV性传播的基因网络，并通过该基因网络调查与HIV性传播相关的因素。
这是一项在中国广西开展的纵向基因网络研究。分别于2015年对HIV患者进行基线调查，并于2016年至2018年对新诊断患者进行随访研究。采用广义估计方程模型，通过新诊断的HIV患者（2016 - 2018年）与基线患者（2015 - 2017年）之间的基因连锁关系，探索与HIV传播相关的因素。
在3259条已鉴定的HIV患者序列中，2714例患者处于基线状态，545例为随访时新诊断的HIV患者。通过重复测量分析共观察到8691个基线指标。接受治疗的HIV患者中，HIV传播的预防效果为33%[调整优势比（AOR）：0.67，95%置信区间（CI）：0.48 - 0.93]。分层分析表明，病毒载量（VL）<50拷贝/ml的接受治疗的HIV患者以及VL<50拷贝/ml且接受治疗4年的患者中，HIV传播的预防效果分别为41%[AOR：0.59，95%CI：0.43 - 0.82]和65%[AOR：0.35，95%CI：0.24 - 0.50]。VL缺失的接受治疗的HIV患者或失访的接受治疗的HIV患者中，HIV传播没有显著减少。一些因素与HIV传播相关，包括年龄超过50岁、男性、壮族及其他民族、学历低于初中、职业为农民以及异性传播。
本研究揭示了ART在减少HIV传播中的作用，在人群层面，学历低于初中的老年男性农民感染HIV的风险较高。在扩大ART期间，迫切需要提高HIV患者的ART疗效，并对高危个体进行精准干预。
