Background

Population-level prevalence of detectable HIV viraemia (PDV) has been proposed as a metric for monitoring the population-level effectiveness of HIV treatment as prevention. We aimed to characterise temporal changes in PDV in people who inject drugs (PWID) and men who have sex with men (MSM) in India and evaluate community-level and individual-level associations with cross-sectional HIV incidence.

Methods

We did a serial cross-sectional study in which baseline (from Oct 1, 2012, to Dec 19, 2013) and follow-up (from Aug 1, 2016, to May 28, 2017) respondent-driven sampling (RDS) surveys were done in MSM (ten community sites) and PWID (12 community sites) across 21 cities in India. Eligible participants were those aged 18 years or older who provided informed consent and possessed a valid RDS referral coupon. Annualised HIV incidence was estimated with validated multiple-assay algorithms. PDV was calculated as the percentage of people with detectable HIV RNA (>150 copies per mL) in a community site. Community-level associations were determined by linear regression. Multivariable, multilevel Poisson regression was used to assess associations with recent HIV infection.

Findings

We recruited 21 990 individuals in the baseline survey and 21 726 individuals in the follow-up survey. The median community-level HIV incidence estimate increased from 0·9% (range 0·0–2·2) at baseline to 1·5% (0·5–3·0) at follow-up in MSM and from 1·6% (0·5–12·4) to 3·6% (0·0–18·4) in PWID. At the community-level, every 1 percentage point increase in baseline PDV and temporal change in PDV between surveys was associated with higher annualised HIV incidence at follow-up: for baseline PDV β=0·41 (95% CI 0·18–0·63) and for change in PDV β=0·52 (0·38–0·66). After accounting for individual-level risk factors, every 10 percentage point increase in baseline PDV and temporal change in PDV was associated with higher individual-level risk of recent HIV infection at follow-up: adjusted risk ratio 1·85 (95% CI 1·44–2·37) for baseline PDV and 1·81 (1·43–2·29) for change in PDV.

Interpretation

PDV was temporally associated with community-level and individual-level HIV incidence. These data support scale-up of treatment as prevention programmes to reduce HIV incidence and the programmatic use of PDV to monitor community HIV risk potential.

Funding

US National Institutes of Health, Elton John AIDS Foundation.

中文翻译：

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印度主要人群中可检测到的 HIV 病毒血症人群水平流行率的时间变化及其与 HIV 发病率的关系：一项连续横断面研究

背景

已提出可检测 HIV 病毒血症 (PDV) 的人群水平流行率作为监测 HIV 治疗作为预防的人群水平有效性的指标。我们旨在描述印度注射吸毒者 (PWID) 和男男性行为者 (MSM) 中 PDV 的时间变化，并评估社区层面和个人层面与横断面 HIV 发病率的关联。

方法

我们进行了一项系列横断面研究，其中基线（从 2012 年 10 月 1 日到 2013 年 12 月 19 日）和随访（从 2016 年 8 月 1 日到 2017 年 5 月 28 日）的受访者驱动抽样 (RDS) 调查是在印度 21 个城市的 MSM（十个社区站点）和 PWID（12 个社区站点）中完成。符合条件的参与者是那些提供知情同意并拥有有效 RDS 推荐券的 18 岁或以上的人。使用经过验证的多重分析算法估计年度 HIV 发病率。PDV 计算为社区站点中可检测到 HIV RNA（>150 拷贝/mL）的人的百分比。社区层面的关联由线性回归确定。多变量、多水平泊松回归用于评估与近期 HIV 感染的关联。

发现

我们在基线调查中招募了 21 990 人，在后续调查中招募了 21 726 人。在 MSM 中，社区层面 HIV 发病率中位数估计值从基线时的 0·9%（范围 0·0-2·2）增加到随访时的 1·5%（0·5-3·0），从 1· PWID 中 6% (0·5–12·4) 到 3·6% (0·0–18·4)。在社区层面，基线 PDV 和调查之间 PDV 的时间变化每增加 1 个百分点与随访时更高的年度 HIV 发病率相关：基线 PDV β=0·41（95% CI 0·18-0 ·63) 和 PDV 的变化 β=0·52 (0·38–0·66)。在考虑了个体层面的风险因素后，基线 PDV 和 PDV 的时间变化每增加 10 个百分点与随访中近期 HIV 感染的个体层面风险较高相关：

解释

PDV 与社区层面和个人层面的 HIV 发病率在时间上相关。这些数据支持扩大治疗作为预防计划以降低 HIV 发病率，以及计划性使用 PDV 来监测社区 HIV 潜在风险。

资金

美国国立卫生研究院，埃尔顿约翰艾滋病基金会。