人类免疫缺陷病毒共感染夫妻艾滋病相关危险行为网络及分子流行病学研究

HIV related risky behavioral network and molecular epidemiology of HIV seroconcordant couples in Taizhou municipality of Zhejiang Province

目的：了解浙江省台州市HIV共感染夫妻（以下简称“双阳夫妻”）双方危险行为及行为网络特征，判断双方HIV传播关系。方法：以2008至2011年期间浙江省台州市艾滋病疫情报告中双阳夫妻为研究对象，分别调查双阳夫妻各自在HIV诊断前艾滋病相关危险行为及行为网络信息。综合危险行为及行为网络、流行病学信息和分子生物学结果判断双阳夫妻间HIV传播关系。结果：共有27对双阳夫妻纳入本次研究，HIV基因亚型以CRF01-AE（61．1％）为主。男性（88．9％，24／27）报告多性伴比例高于女性（37．0％，8／27）。共有20对双阳夫妻仅一方报告有多性伴（其中17例为男性配偶，3例为女性配偶）。综合行为学和分子生物学信息判断，20对双阳夫妻存在直接HIV传播，4对存在潜在的HIV传播，3对不存在HIV互相传播即存在不同的HIV感染来源。另外，在27个行为网络中，有4个网络共6例未接受抗病毒治疗的HIV感染者存在HIV耐药（即原发性耐药），其中2对双阳夫妻存在HIV耐药传播。结论：台州市HIV双阳夫妻双方感染HIV的病毒株亚型呈现多样性，CRF01-AE是主要类型。一方高危行为感染后经婚内性传播是夫妻人群感染HIV的主要模式。个别HIV感染个体存在原发性耐药，并提示存在夫妻间HIV耐药传播的潜在风险。因此，建议在婚前向配偶双方同时提供HIV检测和咨询服务，以减少夫妻间HIV二代传播。

Obstract： To characterize and analyze risky sexual networks and genetic scales to potential HIV transmission for HIV seroeoncordant couples in Taizhou municipality of Zhejiang Province. Methods： HIV seroconcordant positive couples were invited as index cases to participate in an egocentric survey on HIV related risky behavior and behavioral network prior to HIV diagnosis during 2008-2011. Within- couple HIV transmission pairs were determined by the combination of both behavioral and phylogenetic analysis. Results： Totally 27 HIV seroconcordant couples were enrolled in this study. Male spouses were more likely to report having two or more sexual partners in the past years prior to HIV diagnosis than female spouses （ 88.9% vs. 37.0% ）. Among 27 couples, 20 couples including 17 couples by male but not female spouses, 3 couples by female but not male spouses reported having two or more sexual partners （ i. e. , multiple sexual partners） prior to HIV diagnosis ; and 7 couples by both spouses reported having multiple sexual partners. Twenty four of 27 sexual networks were determined to be HIV transmission pairs （20） or potential transmission pairs （4）, 3 couples were subtyped with discordant HIV subtypes or large genetic distance and thus had different sources of HIV transmissions. In addition, among 27 concordant couples, HIV drug resistance （HIVDR） or primary HIVDR existed in 6 ART-na＇fve participants in 4 networks; among them, 2 networks were determined to be potential HIVDR transmission couple pairs. Conclusions： The HIV strains isolated in HIV infected spouses characterized with diversity and CRF01_AE was the main strain subtype. One of the spouses with risky behavior infected HIV was the main route of transmission to other spouses through unprotected sexual contacts. HIVDR was isolated from some HIV infected individuals, suggesting the risk for HIVDR transmission in married couples. The results provide enhanced evidence for urgent development of tailored prevention strategies, such as couple-based HIV counseling and testing services to reduce HIV secondary transmission.