荷兰阿姆斯特丹近期获得性艾滋病毒感染监测:检测地点的归因
Monitoring Recently Acquired HIV Infections in Amsterdam, The Netherlands: The Attribution of Test Locations.
作者信息
Slurink Isabel A L, van de Baan Frank, van Sighem Ard I, van Dam Alje P, van de Laar Thijs J W, de Bree Godelieve J, van Benthem Birgit H B, Op de Coul Eline L M
机构信息
National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Epidemiology and Surveillance, Bilthoven, Netherlands.
Stichting HIV Monitoring, Amsterdam, Netherlands.
出版信息
Front Reprod Health. 2021 Feb 10;3:568611. doi: 10.3389/frph.2021.568611. eCollection 2021.
Surveillance of recent HIV infections (RHI) using an avidity assay has been implemented at Dutch sexual health centres (SHC) since 2014, but data on RHI diagnosed at other test locations is lacking. Implementation of the avidity assay in HIV treatment clinics for the purpose of studying RHI among HIV patients tested at different test locations. We retrospectively tested leftover specimens from newly diagnosed HIV patients in care in 2013-2015 in Amsterdam. Avidity Index (AI) values ≤0.80 indicated recent infection (acquired ≤6 months prior to diagnosis), and AI > 0.80 indicated established infection (acquired >6 months prior to diagnosis). An algorithm for RHI was applied to correct for false recency. Recency based on this algorithm was compared with recency based on epidemiological data only. Multivariable logistic regression analysis was used to identify factors associated with RHI among men who have sex with men (MSM). We tested 447 specimens with avidity; 72% from MSM. Proportions of RHI were 20% among MSM and 10% among heterosexuals. SHC showed highest proportions of RHI (27%), followed by GPs (15%), hospitals (5%), and other/unknown locations (11%) ( < 0.001). Test location was the only factor associated with RHI among MSM. A higher proportion of RHI was found based on epidemiological data compared to avidity testing combined with the RHI algorithm. SHC identify more RHI infections compared to other test locations, as they serve high-risk populations and offer frequent HIV testing. Using avidity-testing for surveillance purposes may help targeting prevention programs, but the assay lacks robustness and its added value may decline with improved, repeat HIV testing and data collection.
自2014年以来,荷兰性健康中心(SHC)一直采用亲和力检测法对近期HIV感染(RHI)进行监测,但缺乏在其他检测地点诊断出的RHI数据。为了研究在不同检测地点接受检测的HIV患者中的RHI情况,在HIV治疗诊所实施了亲和力检测法。我们回顾性检测了2013年至2015年在阿姆斯特丹接受治疗的新诊断HIV患者的剩余样本。亲和力指数(AI)值≤0.80表明近期感染(诊断前≤6个月感染),AI>0.80表明既往感染(诊断前>6个月感染)。应用一种RHI算法来校正假近期感染情况。将基于该算法的近期感染情况与仅基于流行病学数据的近期感染情况进行比较。采用多变量逻辑回归分析来确定男男性行为者(MSM)中与RHI相关的因素。我们用亲和力检测法检测了447份样本;其中72%来自MSM。MSM中的RHI比例为20%,异性恋者中的比例为10%。SHC的RHI比例最高(27%),其次是全科医生诊所(15%)、医院(5%)以及其他/未知地点(11%)(<0.00-1)。检测地点是MSM中与RHI相关的唯一因素。与结合RHI算法的亲和力检测相比,基于流行病学数据发现的RHI比例更高。与其他检测地点相比,SHC发现的RHI感染更多,因为它们服务于高危人群并提供频繁的HIV检测。将亲和力检测用于监测目的可能有助于确定预防项目的目标人群,但该检测缺乏稳健性,且随着HIV检测和数据收集的改进与重复,其附加值可能会下降。