Sources of HIV infection among men having sex with men and implications for prevention

Autor: Peter Reiss, Daniela Bezemer, Ard van Sighem, Alexandra Gavryushkina, Oliver Ratmann, Suzanne Jurriaans, Athena observational cohort, Frank de Wolf, Annemarie M. J. Wensing, Christophe Fraser
Přispěvatelé: Wellcome Trust, Medical Research Council (MRC), Commission of the European Communities, Bill & Melinda Gates Foundation, Medical Microbiology and Infection Prevention, Other departments, AII - Amsterdam institute for Infection and Immunity, APH - Amsterdam Public Health, Global Health
Jazyk: angličtina
Rok vydání: 2015
Předmět:
0301 basic medicine
Counterfactual thinking
Gerontology
Adult
Male
medicine.medical_specialty
media_common.quotation_subject
MEDLINE
IMMUNODEFICIENCY-VIRUS TRANSMISSION
HIV Infections
Research & Experimental Medicine
Article
03 medical and health sciences
PHYLOGENETICS
0302 clinical medicine
Epidemiology
Journal Article
Medicine
Humans
CARE CONTINUUM
EPIDEMIOLOGY
030212 general & internal medicine
Men having sex with men
Homosexuality
Homosexuality
Male
Phylogeny
media_common
Netherlands
Medicine(all)
RISK
Science & Technology
business.industry
Transmission (medicine)
Incidence (epidemiology)
Incidence
WOMEN
General Medicine
Cell Biology
11 Medical And Health Sciences
06 Biological Sciences
3. Good health
030104 developmental biology
Medicine
Research & Experimental
business
ATHENA observational cohort
Life Sciences & Biomedicine
Demography
Cohort study
PREEXPOSURE PROPHYLAXIS
Zdroj: Science Translational Medicine, 8(320). American Association for the Advancement of Science
Science translational medicine, 8(320). American Association for the Advancement of Science
ISSN: 1946-6234
1946-6242
Popis: New HIV diagnoses among men having sex with men (MSM) have not decreased appreciably in most countries, even though care and prevention services have been scaled up substantially in the past 20 years. To maximize the impact of prevention strategies, it is crucial to quantify the sources of transmission at the population level. We used viral sequence and clinical patient data from one of Europe's nationwide cohort studies to estimate probable sources of transmission for 617 recently infected MSM. Seventy-one percent of transmissions were from undiagnosed men, 6% from men who had initiated antiretroviral therapy (ART), 1% from men with no contact to care for at least 18 months, and 43% from those in their first year of infection. The lack of substantial reductions in incidence among Dutch MSM is not a result of ineffective ART provision or inadequate retention in care. In counterfactual modeling scenarios, 19% of these past cases could have been averted with current annual testing coverage and immediate ART to those testing positive. Sixty-six percent of these cases could have been averted with available antiretrovirals (immediate ART provided to all MSM testing positive, and preexposure antiretroviral prophylaxis taken by half of all who test negative for HIV), but only if half of all men at risk of transmission had tested annually. With increasing sequence coverage, molecular epidemiological analyses can be a key tool to direct HIV prevention strategies to the predominant sources of infection, and help send HIV epidemics among MSM into a decisive decline.
Databáze: OpenAIRE
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