Sánchez María S, Grant Robert M, Porco Travis C, Getz Wayne M
University of California, Berkeley, California 94720, USA.
Emerg Infect Dis. 2006 Feb;12(2):191-7. doi: 10.3201/eid1202.050321.
Observed declines in drug resistance to nucleoside reverse transcriptase inhibitors among persons recently infected with HIV-1 in monitored subpopulations can be interpreted as a positive sign and lead public health officials to decrease efforts towards HIV prevention. By means of a mathematical model, we identified 3 processes that can account for the observed decline: increase in high-risk behavior, decrease in proportion of acutely infected persons whose conditions are treated, and change in treatment efficacy. These processes, singly or in combination, can lead to increases or decreases in disease and drug-resistance prevalence in the general population. We discuss the most appropriate public health response under each scenario and emphasize how further data collection and analyses are required to more reliably evaluate the observed time trends and the relative importance of forces shaping the epidemic. Our study highlights how drug resistance markers can be used as epidemiologic sentinels to devise public health solutions.
在受监测的亚人群中，近期感染HIV-1的人群对核苷类逆转录酶抑制剂的耐药性出现下降，这一现象可被视为积极信号，并导致公共卫生官员减少在HIV预防方面的努力。通过一个数学模型，我们确定了3个能够解释所观察到的耐药性下降的过程：高危行为增加、接受治疗的急性感染患者比例下降以及治疗效果的变化。这些过程单独或共同作用，可导致一般人群中疾病和耐药性流行率的上升或下降。我们讨论了每种情况下最适当的公共卫生应对措施，并强调需要进一步收集和分析数据，以便更可靠地评估所观察到的时间趋势以及影响该流行病的各种因素的相对重要性。我们的研究强调了耐药性标志物如何可被用作流行病学哨兵，以制定公共卫生解决方案。
