男男性行为人群HIV/AIDS及其性伴的分子传播关系分析

目的 了解浙江省MSM HIV/AIDS与性伴之间分子传播关系和相关危险因素。方法 采用横断面调查的方法，对浙江省2015-2017年新确证的MSM HIV/AIDS及参与性伴驱动检测的阳性性伴开展分子流行病学研究。收集血浆并提取RNA，运用RT-PCR和巢式PCR扩增并获得HIV-1的pol区基因序列，构建系统进化树，分析分子传播簇，判定性伴间的传播关系。结果 共937例MSM HIV/AIDS参与性伴驱动检测，检出173名阳性性伴。有61例性伴间（31对）形成传播簇，成簇比例为50.8%（61/120），其中7对性伴结合新发感染结果初步判定传播方向。在性伴分子传播网络的相关因素分析中，性伴之间确证年份为相同年份（与不同年份相比，OR=12.190，95%CI：1.563~95.054），现住址所在地为不同区（县）与相同区（县）相比，OR=17.054，95%CI：1.742~166.982]更可能存在分子传播关系。结论 MSM HIV/AIDS的性伴驱动检测，结合分子传播网络分析技术，可以提高HIV/AIDS精准溯源，同时根据新发感染结果，初步判定传播方向。建议对MSM HIV/AIDS确证后，应尽早进行性伴驱动检测，包括跨区域的性伴追踪检测，有利于传染源追踪。

Analysis on the relationship of molecular transmission between HIV infected men who have sex with men and their sexual partners

Objective To investigate the relationship between HIV-infected men who have sex with men and their sexual partners in Zhejiang province. Methods A cross-sectional survey was conducted to recruit newly confirmed HIV/AIDS among MSM from 2015 to 2017, including sexual partner identification and molecular epidemiological study. Plasma was collected to extract RNA, and the pol gene of HIV-1 was amplified by RT-PCR/nested PCR. Phylogenetic tree and molecular transmission cluster were analyzed to identify the transmission relationship between sexual partners. Results A total of 937 HIV/AIDS among MSM were recruited to promote HIV testing for their sexual partners, and 173 positive sexual partners were identified. 50.8% (61/120) of the gene sequences were clustered among the positive sex partners. Seven pairs of clustered sex partners combined with the results of recent infection preliminarily determined the transmission direction. In the clusters, there were statistical differences between the partners who were diagnosed in the same year (OR=12.190, 95%CI:1.563-95.054) or with current residence in the different districts (OR=17.054, 95%CI:1.742-166.982). Conclusions Combined with a molecular transmission network, HIV test for the sexual partners of HIV/AIDS among MSM can improve the accurate tracking of cases and preliminarily determine the direction of transmission, according to the results of recent infection. It is suggested that after HIV is confirmed for HIV/AIDS among MSM, HIV tests should be carried out as soon as possible for their sexual partners, including a cross-regional sexual partner tracking test, which is helpful to improve the tracing procedure.