MCR/UVRI Uganda Research Unit on AIDS, Uganda Virus Research Institute, Entebbe, Uganda.
Curr Opin HIV AIDS. 2010 Jan;5(1):6-11. doi: 10.1097/COH.0b013e32833384d3.
To review data related to the outcomes of antiretroviral therapy (ART) and the current operational experiences of ART programmes in low-income and middle-income countries (LMICs), concentrating on the implications and feasibility of changing ART initiation practice.
ART initiation practice inhigh-income country settings has been modified in favour of starting ART earlier, basing on early evidence that HIV-associated morbidity and mortality are significantly reduced, and because there are increasingly more potent less toxic antiretroviral drug options available.In LMICs, ART initiation continues to follow conservative practice. At the same time, reports from ART programmes in low-income settings continue to demonstrate great benefits in terms of survival for people with HIV. However, compared with high-income country settings, the clinical outcomes of ART in LMICs are less favourable. The enormous HIV disease burden coupled with weaker health service capability is a key challenge to expanding ART effectively, although, as ART programmes mature, there are early indications that patient outcomes may be improving.
In the immediate term, whether it is feasible to move to wide-scale earlier initiation of ART in LMICs remains in question; the priority for many countries is still equity and meeting the unmet needs for treatment. However, the possibility that early ART could reduce the risk of HIV transmission presents a particularly compelling incentive for earlier treatment in the high-burden settings of LMICs and further evidence on this rationale is anticipated from ongoing and planned studies.
回顾抗逆转录病毒疗法（ART）的结果数据，以及中低收入国家（LMIC）中 ART 项目的当前运行经验，重点关注改变 ART 起始治疗实践的意义和可行性。
高收入国家的 ART 起始治疗实践已有所改变，倾向于更早开始 ART，这基于早期证据表明，HIV 相关发病率和死亡率显著降低，而且现在有越来越多的更有效、毒性更小的抗逆转录病毒药物可供选择。在 LMIC，ART 起始治疗仍遵循保守实践。与此同时，来自低收入国家 ART 项目的报告继续证明，接受 HIV 治疗的人群在生存方面有很大的获益。然而，与高收入国家相比，ART 在 LMIC 的临床结果不太理想。巨大的 HIV 疾病负担加上较弱的卫生服务能力，是有效扩大 ART 的一个关键挑战，尽管随着 ART 项目的成熟，有早期迹象表明患者的预后可能正在改善。
短期内，在 LMIC 广泛推广更早开始 ART 是否可行仍存在疑问；许多国家的优先事项仍然是公平性和满足治疗需求。然而，早期 ART 可能降低 HIV 传播风险，这为在 HIV 负担沉重的 LMIC 中更早进行治疗提供了一个特别有说服力的理由，并且正在进行和计划中的研究有望提供更多关于这一原理的证据。
