van de Vijver David A M C, Derdelinckx Inge, Boucher Charles A B
Department of Virology, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
J Infect Dis. 2009 May 1;199(9):1310-7. doi: 10.1086/597804.
Preexposure prophylaxis (PrEP) with antiretroviral drugs may prevent transmission of human immunodeficiency virus (HIV). Our objective was to predict whether PrEP, in the presence of circulating drug resistance, will reduce the risk of infection with HIV.
We used risk equations to calculate the monthly risk of infection with HIV before and after the introduction of PrEP. Uncertainty and sensitivity analyses were performed for 2 ranges of PrEP effectiveness (40%-60% and 60%-80%). Circulating drug resistance was assumed to reduce the effectiveness of PrEP by 50%-90% and the transmissibility of HIV by 0%-30%. Parameter ranges were chosen for women 17-29 years of age from publications on HIV in Manicaland in Zimbabwe.
PrEP would decrease the median risk of HIV transmission by 21%-33% (effectiveness of PrEP, 40%-60% and 60%-80%). If 50% of HIV strains are drug resistant, then the median risk reduction would be 19%-26% if drug-resistant strains were less transmissible than wild-type HIV and 12%-19% if they were equally transmissible. The risk would increase if condoms were frequently replaced with PrEP. Use of PrEP for sexual acts for which no protection is currently used would be beneficial.
The public health impact of PrEP will depend on its effectiveness and on risk behavior. Circulating drug resistance will have only a small impact on the effectiveness of PrEP.
使用抗逆转录病毒药物进行暴露前预防（PrEP）可能会预防人类免疫缺陷病毒（HIV）的传播。我们的目标是预测在存在循环耐药性的情况下，PrEP是否会降低HIV感染风险。
我们使用风险方程来计算引入PrEP前后每月的HIV感染风险。针对PrEP有效性的2个范围（40%-60%和60%-80%）进行了不确定性和敏感性分析。假设循环耐药性使PrEP的有效性降低50%-90%，并使HIV的传播性降低0%-30%。根据津巴布韦马尼卡兰地区关于HIV的出版物，为17-29岁的女性选择了参数范围。
PrEP将使HIV传播的中位数风险降低21%-33%（PrEP有效性为40%-60%和60%-80%）。如果50%的HIV毒株具有耐药性，那么当耐药毒株的传播性低于野生型HIV时，中位数风险降低将为19%-26%；当它们的传播性相当时，中位数风险降低将为12%-19%。如果频繁用PrEP替代避孕套，风险将会增加。将PrEP用于目前没有保护措施的性行为会有益处。
PrEP对公共卫生的影响将取决于其有效性和风险行为。循环耐药性对PrEP有效性的影响将很小。
