Monitoring HIV population viral load (PVL) has been advocated as an important means of inferring HIV transmission potential and predicting the future rate of new HIV infections (HIV incidence) in a particular community. However, the relationship between PVL measures and directly measured HIV incidence has not been quantified in any setting and, most importantly, in a hyperendemic sub-Saharan African setting. We assessed this relationship using one of Africa’s largest population-based prospective population cohorts in rural KwaZulu-Natal, South Africa in which we followed 8732 HIV-uninfected participants between 2011 and 2015. Despite clear evidence of spatial clustering of high viral loads in some communities, our results demonstrate that PVL metrics derived from aggregation of viral load data only from the HIV-positive members of a particular community did not predict HIV incidence in this typical hyperendemic, rural African population. Only once we used modified PVL measures, which combined viral load information with the underlying spatial variation in the proportion of the population infected (HIV prevalence), did we find a consistently strong relationship with future risk of HIV acquisition. For example, every 1% increase in the overall proportion of a population having detectable virus (PDV_P) was independently associated with a 6.3% increase in an individual’s risk of HIV acquisition (P = 0.001). In hyperendemic African populations, these modified PVL indices could play a key role in targeting and monitoring interventions in the most vulnerable communities where the future rate of new HIV infections is likely to be highest.

一直以来，监测HIV人口的病毒载量（PVL）被认为是推断HIV传播潜力和预测特定社区未来HIV新感染率（HIV发病率）的重要手段。但是，PVL测度和直接测得的HIV发病率之间的关系在任何情况下都没有量化，最重要的是在撒哈拉以南非洲高流行地区。我们使用南非夸祖鲁-纳塔尔省农村地区最大的以人口为基础的预期人群队列来评估这种关系，在2011年至2015年间，我们追踪了8732名未感染HIV的参与者。 ，我们的结果表明，仅从特定社区的HIV阳性成员的病毒载量数据汇总中得出的PVL指标不能预测这种典型的高流行性非洲农村人口中的HIV发生率。仅当我们使用修改后的PVL测度（将病毒载量信息与感染人群比例的潜在空间变化（HIV患病率）结合起来）时，我们才发现其与未来HIV感染风险的密切相关性。例如，在具有可检测病毒（PDV）的人群中，总体比例每增加1％结合了病毒载量信息和感染人群比例的潜在空间变化（HIV患病率），我们是否发现与HIV感染的未来风险之间存在着长期稳定的关系。例如，在具有可检测病毒（PDV）的人群中，总体比例每增加1％结合了病毒载量信息和感染人群比例的潜在空间变化（HIV患病率），我们是否发现与HIV感染的未来风险之间存在着长期稳定的关系。例如，在具有可检测病毒（PDV）的人群中，总体比例每增加1％_P）与个体感染HIV的风险增加6.3％（ P = 0.001）独立相关。在非洲高流行病人群中，这些经过修改的PVL指数可能在针对和监测最脆弱社区的干预措施中发挥关键作用，在这些社区中，未来新感染HIV的可能性最高。