广州市2008-2015年男男性行为者感染HIV-1的分子传播网络特征

Characteristics of HIV-1 molecular transmission network among HIV-1 positive men who have sex with men in Guangzhou from 2008 to 2015

目的了解广州市男男性行为者(MSM)的1型艾滋病病毒(HIV-1)感染者中分子网络传播特征及相关影响因素。方法对2008-2015年广州市新报告MSM感染者采集血样。通过核糖核酸提取和测序、基因片段整理、HIV-1分子传播网络构建来探究传播特征。分类资料使用χ2检验,使用多因素Logistic回归模型分析成簇样本和高危传播者的相关影响因素。结果HIV-1分子传播网络由184个传播簇,690个节点和990条边构成。成簇样本有690个,文化程度、籍贯和亚型分布与是否成簇有关联。多因素Logistic回归结果显示,文化程度为高中及中专[与初中及以下的人群相比,调整比值比(aOR)=1.45,95%可信区间(CI):1.10~1.91]和大专及以上(aOR=1.31,95%CI:1.01~1.70)、非本市(与本市的人群相比,aOR=1.31,95%CI:1.06~1.63)、感染HIV-1序列为CRF07BC(与CRF01AE亚型相比,aOR=1.12,95%CI:0.89~1.40)和CRF5501B(aOR=1.48,95%CI:1.11~1.97)的MSM HIV-1感染者更容易与他人相连构成传播簇。度值≥3的高危传播者有223个,文化程度、职业、性接触史、同性性伴数、籍贯和亚型与高危传播者有关联。多因素Logistic回归结果显示,干部职员(与职业为服务业的人群相比,aOR=1.86,95%CI:1.03~3.35)和学生(aOR=1.96,95%CI:1.12~3.46)、同性性伴数≥10(与同性性伴数≤2的人群相比,aOR=2.02,95%CI:1.20~3.39)、感染HIV-1序列为CRF5501B(与CRF01AE亚型相比,aOR=1.78,95%CI:1.12~2.84)的MSM HIV-1感染者更容易成为高危传播者。结论通过HIV-1分子传播网络构建和特征分析可以有效识别出广州市MSM HIV-1感染者中精准干预对象,为传染源管理提供参考依据。

Objective To understand the characteristics and related influencing factors of the molecular transmission network among HIV-1 positive MSM in Guangzhou.Methods Blood samples were collected from newly reported HIV-1 positive MSM from 2008 to 2015.The transmission characteristics were explored through RNA extraction and sequencing,gene fragment sorting,and construction of HIV-1 molecular transmission network.Categorical data was assessed by chi-square test.Influencing factors associated with clustered samples and super-spreaders were analyzed by multivariate logistic regression.Results The HIV-1 molecular transmission network consisted of 184 transmission clusters,690 nodes and 990 edges.There were 690 clustered samples,and the education level,native place and virus subtype distribution were associated with the clustering.Multivariate logistic regression showed that HIV-1 positive MSM were more likely to connect with others to create a transmission cluster,who had education level of senior high school or specialized secondary school(compared with education level of junior high school or below,aOR=1.45,95%CI:1.10-1.91),college or above(compared with education level of junior high school or below,aOR=1.31,95%CI:1.01-1.70),registered household outside Guangzhou(compared with those in Guangzhou,aOR=1.31,95%CI:1.06-1.63),virus subtype of CRF07BC(compared with that of CRF01AE,aOR=1.12,95%CI:0.89-1.40),and CRF5501 B(compared with that of CRF01AE,aOR=1.48,95%CI:1.11-1.97).There were 223 super-spreaders with degree of 3 or above.Education level,occupation,history of sexual contact,number of homosexual partners,native place and virus subtype were associated with super-spreaders.Multivariate logistic regression showed that HIV-1 positive MSM were more likely to become super-spreaders,who were cadres(compared with those working in service industry,aOR=1.86,95%CI:1.03-3.35),students(compared with those in service industry,aOR=1.96,95%CI:1.12-3.46),numbers of homosexual partners≥10(compared with those≤2,aOR=2.02,95%CI:1.20-3.39),infected with virus subtype of CRF5501 B(compared with that of CRF01AE,aOR=1.78,95%CI:1.12-2.84).Conclusion The construction of HIV-1 molecular transmission network and characteristic analysis can effectively identify the target of precise intervention among HIV-1 positive MSM in Guangzhou,and provide reference for the management of infection sources.