2017-2022 年,在 n = 6059 名性与性别少数群体男男性行为者的 4 年美国全国队列中,与 PrEP 时期艾滋病毒血清转换相关的因素

IF 4.6 1区 医学 Q2 IMMUNOLOGY
Christian Grov, Yan Guo, Drew A. Westmoreland, Alexa B. D'Angelo, Chloe Mirzayi, Michelle Dearolf, Pedro Carneiro, Meredith Ray, David Pantalone, Adam W. Carrico, Viraj V. Patel, Sarit A. Golub, Sabina Hirshfield, Donald R. Hoover, Denis Nash
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This cohort study examined the association of several risk factors with subsequent HIV seroconversion.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We report data from a 4-year study (2017−2022) of 6059 HIV seronegative sexual and gender minority individuals who have sex with men who had indications for-, but were not using-, PrEP at enrolment. Participants completed repeat exposure assessments and self-collection of biospecimens for HIV testing. We examined the roles of race and ethnicity, socio-economic status, methamphetamine use and PrEP uptake over the course of follow-up in relation to HIV seroconversion.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Over 4 years, 303 of the participants seroconverted across 18,421 person-years (incidence rate = 1.64 [95% CI: 1.59−1.70] per 100 person-years). In multivariable discrete-time survival analysis, factors independently associated with elevated HIV seroconversion risk included being Black/African American (adjusted risk ratio [aRR]: 2.44, 1.79−3.28), Hispanic/Latinx (1.53, 1.19−1.96), housing instability (1.58, 1.22−2.05) and past year methamphetamine use (3.82, 2.74−5.33). Conversely, time since study enrolment (24 vs. 12 months, 0.67, 0.51−0.87; 36 months, 0.60, 0.45−0.80; 48 months, 0.48, 0.35−0.66) and higher education (master's degree or higher vs. less than or equal to high school, 0.36, 0.17−0.66) were associated with reduced seroconversion risk. Compared to non-PrEP users in the past 2 years without a current clinical indication, those who started PrEP but then discontinued had higher seroconversion risk, irrespective of clinical indication (3.23, 1.74−6.46) or lack thereof (4.30, 1.85−9.88). 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引用次数: 0

摘要

引言 以社区为基础的艾滋病血清转换队列研究可以确定在暴露前预防疗法(PrEP)时代加强艾滋病预防工作的重要途径。在个体内部,我们可以重复评估暴露和结果变量,并提高时间排序的确定性。这项队列研究考察了几个风险因素与后续 HIV 血清转换的关系。 方法 我们报告了一项为期 4 年(2017-2022 年)的研究数据,研究对象是 6059 名 HIV 血清阴性的性少数群体和性别少数群体男男性行为者,他们在入组时具有 PrEP 适应症,但并未使用 PrEP。参与者完成了重复暴露评估和自我采集生物样本进行 HIV 检测。我们研究了种族和民族、社会经济地位、甲基苯丙胺使用情况以及在随访过程中使用 PrEP 与 HIV 血清转换之间的关系。 结果 4 年间,303 名参与者在 18,421 人年中发生了血清转换(发生率 = 1.64 [95% CI: 1.59-1.70]/100人年)。在多变量离散时间生存分析中,与 HIV 血清转换风险升高独立相关的因素包括黑人/非裔美国人(调整风险比 [aRR]:2.44,1.79-3.28)、西班牙裔/拉丁裔(1.53,1.19-1.96)、住房不稳定(1.58,1.22-2.05)和过去一年使用甲基苯丙胺(3.82,2.74-5.33)。与此相反,加入研究的时间(24 个月对 12 个月,0.67,0.51-0.87;36 个月,0.60,0.45-0.80;48 个月,0.48,0.35-0.66)和高等教育程度(硕士学位或更高对高中以下,0.36,0.17-0.66)与血清转换风险降低有关。与过去两年中未使用过 PrEP 但目前没有临床指征的人相比,那些开始使用 PrEP 但后来又停止使用的人血清转换风险更高,无论是否有临床指征(3.23,1.74-6.46)或没有临床指征(4.30,1.85-9.88)。然而,在过去一年中开始使用 PrEP(0.14,0.04-0.39)或在过去两年中持续使用 PrEP(0.33,0.14-0.74)的人血清转换风险较低。在随访评估期间(12、24、36 和 48 个月)观察到的所有艾滋病毒血清转换者中,有 128 人(42.2%)报告在 12 个月前吸食过甲基苯丙胺(总体)。 结论 急需采取干预措施,承认种族和民族、经济变量(如教育和住房不稳定性)以及甲基苯丙胺的使用。不仅需要采取干预措施让个人参与 PrEP 治疗,而且鉴于这些群体中血清转换的风险极高,还必须采取干预措施留住他们,并让那些可能脱离治疗的人重新参与治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Factors associated with PrEP-era HIV seroconversion in a 4-year U.S. national cohort of n = 6059 sexual and gender minority individuals who have sex with men, 2017−2022

Introduction

Community-based cohort studies of HIV seroconversion can identify important avenues for enhancing HIV prevention efforts in the era of pre-exposure prophylaxis (PrEP). Within individuals, one can assess exposure and outcome variables repeatedly and with increased certainty regarding temporal ordering. This cohort study examined the association of several risk factors with subsequent HIV seroconversion.

Methods

We report data from a 4-year study (2017−2022) of 6059 HIV seronegative sexual and gender minority individuals who have sex with men who had indications for-, but were not using-, PrEP at enrolment. Participants completed repeat exposure assessments and self-collection of biospecimens for HIV testing. We examined the roles of race and ethnicity, socio-economic status, methamphetamine use and PrEP uptake over the course of follow-up in relation to HIV seroconversion.

Results

Over 4 years, 303 of the participants seroconverted across 18,421 person-years (incidence rate = 1.64 [95% CI: 1.59−1.70] per 100 person-years). In multivariable discrete-time survival analysis, factors independently associated with elevated HIV seroconversion risk included being Black/African American (adjusted risk ratio [aRR]: 2.44, 1.79−3.28), Hispanic/Latinx (1.53, 1.19−1.96), housing instability (1.58, 1.22−2.05) and past year methamphetamine use (3.82, 2.74−5.33). Conversely, time since study enrolment (24 vs. 12 months, 0.67, 0.51−0.87; 36 months, 0.60, 0.45−0.80; 48 months, 0.48, 0.35−0.66) and higher education (master's degree or higher vs. less than or equal to high school, 0.36, 0.17−0.66) were associated with reduced seroconversion risk. Compared to non-PrEP users in the past 2 years without a current clinical indication, those who started PrEP but then discontinued had higher seroconversion risk, irrespective of clinical indication (3.23, 1.74−6.46) or lack thereof (4.30, 1.85−9.88). However, those who initiated PrEP in the past year (0.14, 0.04−0.39) or persistently used PrEP in the past 2 years (0.33, 0.14−0.74) had a lower risk of seroconversion. Of all HIV seroconversions observed during follow-up assessments (12, 24, 36 and 48 months), methamphetamine was reported in the 12 months prior 128 (42.2%) times (overall).

Conclusions

Interventions that acknowledge race and ethnicity, economic variables such as education and housing instability, and methamphetamine use are critically needed. Not only are interventions to engage individuals in PrEP care needed, but those that retain them, and re-engage those who may fall out of care are essential, given the exceptionally high risk of seroconversion in these groups.

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来源期刊
Journal of the International AIDS Society
Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
8.60
自引率
10.00%
发文量
186
审稿时长
>12 weeks
期刊介绍: The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.
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