结合分子传播网络分析和空间流行病学揭示中国南京老年人中 HIV-1 的传播模式。

Combining molecular transmission network analysis and spatial epidemiology to reveal HIV-1 transmission pattern among the older people in Nanjing, China.

机构信息

Department of AIDS/STD Control and Prevention, Nanjing Municipal Central for Disease Control and Prevention, Nanjing, 210003, China.

School of Public Health, Nanjing Medical University, Nanjing, 211166, China.

出版信息

Virol J. 2024 Sep 15;21(1):218. doi: 10.1186/s12985-024-02493-w.

DOI:10.1186/s12985-024-02493-w

PMID:39278908

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11404066/

Abstract

BACKGROUND

In China, the problem of HIV infection among the older people has become increasingly prominent. This study aimed to analyze the pattern and influencing factors of HIV transmission based on a genomic and spatial epidemiological analysis among this population.

METHODS

A total of 432 older people who were aged ≥ 50 years, newly diagnosed with HIV-1 between January 2018 and December 2021 and without a history of ART were enrolled. HIV-1 pol gene sequence was obtained by viral RNA extraction and nested PCR. The molecular transmission network was constructed using HIV-TRACE and the spatial distribution analyses were performed in ArcGIS. The multivariate logistic regression analysis was performed to analyze the factors associated with clustering.

RESULTS

A total of 382 sequences were successfully sequenced, of which CRF07_BC (52.3%), CRF01_AE (32.5%), and CRF08_BC (6.8%) were the main HIV-1 strains. A total of 176 sequences entered the molecular network, with a clustering rate of 46.1%. Impressively, the clustering rate among older people infected through commercial heterosexual contact was as high as 61.7% and three female sex workers (FSWs) were observed in the network. The individuals who were aged ≥ 60 years and transmitted the virus by commercial heterosexual contact had a higher clustering rate, while those who were retirees or engaged other occupations and with higher education degree were less likely to cluster. There was a positive spatial correlation of clustering rate (Global Moran I = 0.206, P < 0.001) at the town level and the highly aggregated regions were mainly distributed in rural area. We determined three large clusters which mainly spread in the intra-region of certain towns in rural areas. Notably, 54.5% of cases in large clusters were transmitted through commercial heterosexual contact.

CONCLUSIONS

Our joint analysis of molecular and spatial epidemiology effectively revealed the spatial aggregation of HIV transmission and highlighted that towns of high aggregation were mainly located in rural area. Also, we found vital role of commercial heterosexual contact in HIV transmission among older people. Therefore, health resources should be directed towards highly aggregated rural areas and prevention strategy should take critical persons as entry points.

摘要

背景

在中国，老年人中的 HIV 感染问题日益突出。本研究旨在通过对这一人群的基因组和空间流行病学分析，分析 HIV 传播模式及其影响因素。

方法

共纳入 2018 年 1 月至 2021 年 12 月新诊断为 HIV-1 的年龄≥50 岁且无 ART 治疗史的 432 例老年人。通过病毒 RNA 提取和巢式 PCR 获得 HIV-1 pol 基因序列。利用 HIV-TRACE 构建分子传播网络，在 ArcGIS 中进行空间分布分析。采用多因素 logistic 回归分析分析与聚类相关的因素。

结果

共成功测序 382 条序列，其中 CRF07_BC（52.3%）、CRF01_AE（32.5%）和 CRF08_BC（6.8%）为主要 HIV-1 株。共有 176 条序列进入分子网络，聚类率为 46.1%。令人惊讶的是，商业异性性接触感染的老年人中，聚类率高达 61.7%，网络中观察到 3 例女性性工作者（FSWs）。年龄≥60 岁且通过商业异性性接触传播病毒的个体聚类率较高，而退休人员或从事其他职业且受教育程度较高的个体聚类率较低。在镇一级，聚类率存在正空间相关性（全局 Moran I=0.206，P<0.001），高度聚集区主要分布在农村地区。我们确定了三个主要的聚类，它们主要在农村地区某些城镇的内部区域传播。值得注意的是，大聚类中的 54.5%的病例是通过商业异性性接触传播的。