论文标题
在英格兰与男性发生性关系的男性的艾滋病毒传播：在2030年之前淘汰？
HIV transmission in men who have sex with men in England: on track for elimination by 2030?
论文作者
论文摘要
Background: After a decade of a treatment as prevention (TasP) strategy based on progressive HIV testing scale-up and earlier treatment, a reduction in the estimated number of new infections in men-who-have-sex-with-men (MSM) in England had yet to be identified by 2010. To achieve internationally agreed targets for HIV control and elimination, test-and-treat prevention efforts have been dramatically intensified over the period 2010-2015,从2016年开始，通过预防前预防进一步加强（PREP）。 方法：新型年龄分层的背对方法应用于新的HIV诊断和CD4计数诊断的数据，实现了对HIV发病率，未诊断的感染以及在2010-2015和2016-2018周期的特定年龄估计。然后推断出估计的发病率趋势，以量化到2030年实现HIV消除的可能性。 研究结果：MSM的艾滋病毒发病率下降估计是在2012/3年开始的，这是在观察到的新诊断落下的十八个月之前。从2013年的2,770种年度感染（95％可信间隔2.490-3,040）下降到2015年的1,740（1,500-2,010），从2016年开始稳步下降，随后从2016年开始下降，从2018年（441-1,540）的感染率下降，尤其是一个年龄段。 45+组中最慢。在未诊断的感染数量中估计可比下降。 解释：HIV发病率的峰值和随后的急剧下降发生在PREP阶段之前。将消除视为公共卫生威胁<50种新的感染（每10,000种风险的1.1个感染），到2030年，有40％的发病率预测达到了这一阈值。实际上，需要有针对性的政策，尤其是在45+y中，在45+y中，这种情况的增长速度最快。
Background: After a decade of a treatment as prevention (TasP) strategy based on progressive HIV testing scale-up and earlier treatment, a reduction in the estimated number of new infections in men-who-have-sex-with-men (MSM) in England had yet to be identified by 2010. To achieve internationally agreed targets for HIV control and elimination, test-and-treat prevention efforts have been dramatically intensified over the period 2010-2015, and, from 2016, further strengthened by pre-exposure prophylaxis (PrEP). Methods: Application of a novel age-stratified back-calculation approach to data on new HIV diagnoses and CD4 count-at-diagnosis, enabled age-specific estimation of HIV incidence, undiagnosed infections and mean time-to-diagnosis across both the 2010-2015 and 2016-2018 periods. Estimated incidence trends were then extrapolated, to quantify the likelihood of achieving HIV elimination by 2030. Findings: A fall in HIV incidence in MSM is estimated to have started in 2012/3, eighteen months before the observed fall in new diagnoses. A steep decrease from 2,770 annual infections (95% credible interval 2.490-3,040) in 2013 to 1,740 (1,500-2,010) in 2015 is estimated, followed by steady decline from 2016, reaching 854 (441-1,540) infections in 2018. A decline is consistently estimated in all age groups, with a fall particularly marked in the 24-35 age group, and slowest in the 45+ group. Comparable declines are estimated in the number of undiagnosed infections. Interpretation: The peak and subsequent sharp decline in HIV incidence occurred prior to the phase-in of PrEP. Definining elimination as a public health threat to be < 50 new infections (1.1 infections per 10,000 at risk), 40% of incidence projections hit this threshold by 2030. In practice, targeted policies will be required, particularly among the 45+y where STIs are increasing most rapidly.
