在美國被診斷出感染 HIV 的總體終生風險降低了 11%，但種族和地域差異依然存在

資料來源：Krishen Samuel/2022 年 2 月 15 日/aidsmap/財團法人台灣紅絲帶基金會編譯

Sonia Singh 博士（左）在 CROI 2022。

雖然與 2010-2014 年和 2017-2019 年相比，在美國接受 HIV 診斷的總體終生風險下降了 11%——新的估計為 120 分之一——但仍然存在明顯的種族和地理差異，來自美國疾病控制和預防中心的 Sonia Singh 博士昨天向反轉錄病毒和機會性感染會議 (CROI 2022) 報告。

拉丁美洲人、美洲印第安人和白人女性等群體的終生愛滋病毒風險沒有改善。 此外，某些種族群體的終生風險明顯更高：黑人男性的終生風險是白人男性的六倍，而黑人女性的終生風險是白人女性的近 12 倍。 根據您在美國居住的地方，風險也有很大差異，從華盛頓特區的 39 分之一高到懷俄明州的 655 分之一。

研究

為了估計來自美國不同地區的不同種族和性別群體的人終生感染 HIV 的風險，研究人員從國家 HIV 監測系統、全國死亡率數據和人口普查中獲得了 HIV 診斷數據。 該分析是根據 2017 年至 2019 年的數據進行的，並遵循了先前對 2010 年至 2014 年較早時期的研究。

假設 2017 年至 2019 年的診斷率保持不變，則終生風險估計是基於從出生起一生中任何時候接受 HIV 診斷的累積概率。

性別與種族

在每個年齡段，男性被診斷出感染 HIV 的終生風險都高於女性。 總體終生風險因性別而異：男性為 76 分之一，而女性僅為 309 分之一。

就種族差異而言，黑人（27 人中有 1 人）和拉丁裔（50 人中有 1 人）男性的風險最高，但亞洲人（187 人中有 1 人）和白人男性（171 人中有 1 人）的風險最低。 夏威夷原住民/其他太平洋島民（89 人中有 1 人）和美洲印第安人/阿拉斯加原住民（116 人中有 1 人）等群體介於兩者之間。 與白人男性相比，黑人男性一生中被診斷感染 HIV 的風險高 6.3 倍，拉丁裔男性高 3.4 倍。

與 2010-2014 年期間相比，拉丁裔男性的終生風險之前為每 51 人中有 1 人（無變化），黑人男性為每 22 人中有 1 人（近年來風險略有下降），而以下群體的降幅更大，例如 白人男性（140 人中有 1 人）。 美國印第安男性的風險增加（131 人中有 1 人）。

女性在 2017-2019 年遵循類似的種族模式，黑人（75 人中有 1 人）和拉丁裔（287 人中有 1 人）女性風險最高，亞裔女性（1,298 人中有 1 人）和白人女性（874 人中有 1 人）風險最低。 夏威夷原住民/其他太平洋島民（611 人中有 1 人）和美洲印第安人/阿拉斯加原住民（435 人中有 1 人）女性也介於兩者之間。 與白人女性相比，黑人女性一生中被診斷感染 HIV 的風險高 11.7 倍，拉丁裔女性高 3 倍。

回顧 2010-2014 年期間，拉丁裔女性的終生風險為 256 分之一（變化很小），黑人女性的終生風險為 54 分之一（風險降低），而白人女性等群體的風險有所增加（941人中有 1人）。 美洲印第安女性的這一比例基本保持不變（403 人中有 1 人）。

此外，研究人員計算了十年年齡的條件風險：這提供了一個人在接下來的十年內接到 HIV 之診斷的可能性。 對於男性來說，未來十年被診斷出感染 HIV 的風險在 20 歲時最高（195 人中有 1 人），而女性在 30 歲時最高（1,152 人中有 1 人）。

地點

被診斷出感染 HIV 的終生風險因州而異，華盛頓特區（39 人中有 1 人）和喬治亞州（59 人中有 1 人）的風險最高，懷俄明州的風險最低（655 人中有 1 人）。 除了內華達州（84 人中有 1 人）和紐約州（108 人中有 1 人）之外，大多數風險最高的州都位於南部，包括佛羅里達州（63 人中有 1 人）、路易斯安那州（69 人中有 1 人）、密西西比州（90 人中有 1 人） 、馬里蘭州（85 人中有 1 人）和德克薩斯州（93 人中有 1 人）。 國家結束愛滋病毒流行倡議已確定這些南部各州需要緊急減少愛滋病毒傳播。

結論

總體而言，男性和女性終生感染 HIV 的風險均有所下降，但這種下降並未出現在所有種族和族裔群體中。 在美國，終生風險在很大程度上取決於性別、種族和地理界限。

使用終生風險估計值可能是從業者、公共衛生專業人員和外行更有效地就美國和特定社區的總體 HIV 負擔進行交流的有用工具。 這顯示需要在哪些方面加強預防工作。 例如，需要在較年輕的年齡組中強調測試介入，例如二三十歲的人群，其中十歲的條件風險最高。

辛格在新聞發布會上表示，將對特定亞群（例如黑人男同性戀者和雙性戀男性）進行進一步分析，以估計感染愛滋病毒的終生風險。 她強調需要緊急關注結構性因素，這些因素使某些種族群體比其他種族群體更容易面臨更高的終生風險。 然而，她還評論了自上次估計以來取得的進展，提到了作為預防的治療 (treatment as prevention) 和 PrEP 的顯著影響。

參考文獻：

Singh S et al. 估計在美國診斷為 HIV 感染的終生風險。 反轉錄病毒和機會性感染會議，摘要 43，2022 年。

Overall lifetime risk of being diagnosed with HIV in the US decreases by 11%, but stark racial and geographical disparities persist

Krishen Samuel/15 February 2022/aidsmap

Dr Sonia Singh (left) at CROI 2022.

While the overall lifetime risk of receiving an HIV diagnosis in the US has decreased by 11% when comparing 2010-2014 to 2017-2019 – with a new estimate of 1 in 120 – stark racial and geographic disparities remain, Dr Sonia Singh from the US Centers for Disease Control and Prevention reported to the Conference on Retroviruses and Opportunistic Infections (CROI 2022) yesterday.

There has been no improvement in lifetime HIV risk for groups such as Latinx people, American Indians, and White females. Additionally, lifetime risk is markedly higher for some racial groups: Black males have a six times higher lifetime risk than White males, while Black females have a nearly 12 times higher risk than White females. Risk also differs dramatically based on where you live in the US, from a high of 1 in 39 in Washington DC down to 1 in 655 in Wyoming.

The study

In order to estimate lifetime HIV risk for people of different racial and sex groups from different parts of the US, researchers obtained data on HIV diagnoses from the National HIV Surveillance System, national mortality data and census population counts. This analysis was conducted on data from 2017 to 2019 and follows a previous study of an earlier time period, 2010 to 2014.

The lifetime risk estimates are based on the cumulative probability of receiving an HIV diagnosis at any point across the lifespan from birth, assuming that the 2017 to 2019 diagnosis rates continue.

Sex and race

At every age, males had a higher lifetime risk of being diagnosed with HIV than females. The overall lifetime risk differed substantially based on sex: for males, it was 1 in 76, while it was only 1 in 309 for females.

In terms of racial differences, risk was highest among Black (1 in 27) and Latino (1 in 50) males, but lowest among Asian (1 in 187) and White (1 in 171) males. Groups such as Native Hawaiian/Other Pacific Islander (1 in 89) and American Indian/Alaskan Native (1 in 116) fell in between. When compared to White males, Black males had a 6.3 times higher risk and Latino males a 3.4 times higher risk of being diagnosed with HIV in their lifetime.

To compare with the 2010-2014 period, lifetime risk was previously 1 in 51 for Latino males (no change) and 1 in 22 for Black males (slight reduction in risk in recent years), whereas there have been larger reductions for groups such as White males (1 in 140). Risk has increased for American Indian males (1 in 131).

Females followed a similar racial pattern in 2017-2019, with Black (1 in 75) and Latina (1 in 287) females having the highest risk and Asian (1 in 1298) and White (1 in 874) females having the lowest risk. Native Hawaiian/Other Pacific Islander (1 in 611) and American Indian/Alaskan Native (1 in 435) females also fell in between. When compared to White females, Black females had an 11.7 times higher risk and Latina females a 3 times higher risk of being diagnosed with HIV in their lifetime.

Looking back at the 2010-2014 period, lifetime risk was 1 in 256 for Latina females (minimal change) and 1 in 54 for Black females (reduction in risk), whereas there have been increases in risk for groups such as White females (1 in 941). It has remained largely unchanged for American Indian females (1 in 403).

Additionally, the researchers calculated a ten-year age conditional-risk: this provides the probability of a person receiving an HIV diagnosis in the following decade. For males, the risk of being diagnosed with HIV in the next ten years was highest at age 20 (1 in 195), while for females it was highest at age 30 (1 in 1152).

Location

Lifetime risk of being diagnosed with HIV varied widely from state to state, with the highest risk in Washington DC (1 in 39) and Georgia (1 in 59), and the lowest in Wyoming (1 in 655). Apart from Nevada (1 in 84) and New York (1 in 108), most of the highest risk states were located in the south, including Florida (1 in 63), Louisiana (1 in 69), Mississippi (1 in 90), Maryland (1 in 85) and Texas (1 in 93). These southern states have been identified as requiring urgent reductions in HIV transmission by the national Ending the HIV Epidemic initiative. 

Conclusion

Overall, lifetime risk of HIV diagnosis has decreased among both males and females, but this decrease was not seen across all racial and ethnic groups. Lifetime risk continues to be heavily patterned along sex, racial and geographic lines in the US.

Using estimates of lifetime risk may be a useful tool for practitioners, public health professionals and laypeople to communicate more effectively about the burden of HIV overall in the US, and in specific communities. This provides an indication of where prevention efforts need to be strengthened. For instance testing interventions need to be emphasised in younger age groups, such as people in their twenties and thirties, where the ten-year age conditional-risk is highest.

Singh indicated during a press conference that further analyses to estimate HIV lifetime risk would be conducted for specific subgroups, such as Black gay and bisexual men. She emphasised the need to urgently attend to structural factors that predispose certain racial groups to a much higher lifetime risk than others. However, she also remarked on the progress that has been made since the last estimates, mentioning the marked impacts of both treatment as prevention and PrEP.

References

Singh S et al. Estimating the lifetime risk of a diagnosis of HIV infection in the United States. Conference on Retroviruses and Opportunistic Infections, abstract 43, 2022.

View the abstract on the conference website.