社区HIV病毒载量可作为人群病毒载量最优替代指标

Community viral load-an optimal alternative index of population viral load for HIV/AIDS surveillance

目的探讨适用于评估新疆伊宁市HIV传播潜力的人群病毒载量(PVL)最优替代指标。方法建立动态队列研究,监测伊宁市2017—2019年所有HIV/AIDS的病毒载量(VL),计算不同PVL替代指标值,并评估不同PVL替代指标、病毒血症流行率与HIV新发感染率、抗逆转录病毒治疗(ART)覆盖率、病毒抑制率的关联强度。结果新疆伊宁市2017—2019年HIV感染者的不同PVL指标值均呈逐年下降趋势(P<0.05),社区病毒载量(CVL)的减少与HIV新发感染率的增加之间显著相关(r=0.999,P=0.028),CVL与ART覆盖率(r=-1.000,P=0.001)、病毒抑制率(r=-1.000,P=0.010)均呈负相关。以不同VL值为界限的敏感性分析中的病毒血症流行率2(VL>400 copies/mL)和病毒血症流行率3(VL>1000 copies/mL)与HIV新发感染率呈正相关(r^(2)=0.997,P^(2)=0.048;r^(3)=0.998,P^(3)=0.041),与ART覆盖率(r^(2)=-1.000,P^(2)=0.019;r^(3)=-1.000,P^(3)=0.012)、病毒抑制率(r^(2)=-1.000,P^(2)=0.010;r^(3)=-1.000,P^(3)=0.003)均呈负相关。结论CVL为PVL最优替代指标,可与病毒血症流行率共同评估新疆伊宁市HIV传播潜力。

Objective To explore an optimal alternative index of population viral load(PVL)suitable for assessing potential human immunodeficiency virus(HIV)transmission in the population of Yining city,Xinjiang Uygur Autonomous Region.Methods All previously and newly diagnosed HIV/AIDS cases aged≥13 years were recruited into a dynamic cohort in Yining city from 2017 through 2019.Questionnaire interviews and viral load(VL)monitoring were conducted among all the HIV/AIDS cases.Based on the data collected,PVL,monitored viral load(MVL),in-care viral load(ICVL),aware viral load(AVL),and community viral load(CVL)were calculated and viremia prevalence,HIV infection incidence,antiretroviral therapy(ART)coverage,and viral inhibition rate were estimated.Correlations among the indicators were assessed.Results All values of PVL,MVL,ICVL,and AVL decreased significantly during the 3-year period(all P<0.05).The decrease in CVL were significantly correlated with the increase in HIV infection incidence(r=0.999,P=0.028).The CVL is inversely correlated with ART coverage(r=-1.000,P=0.001)and virus inhibition rate(r=-1.000,P=0.010).The viremia prevalence rates with specific VL cut-off values were significantly correlated positively with HIV infection incidence(for VL>400 copies/m:r=0.997,P=0.048 and for VL>1000 copies/mL:r=0.998,P=0.041)but inversely with ART coverage(r=-1.000,P=0.019 and r=-1.000,P=0.012)and virus suppression rate(r=-1.000,P=0.010 and r=-1.000,P=0.003).Conclusion CVL is the most optimal alternative index of PVL and could be adopted together with viremia prevalence rate in assessment on potential HIV transmission intensity.