Wester C William, Bussmann Hermann, Koethe John, Moffat Claire, Vermund Sten, Essex Max, Marlink Richard G
Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research & Education (BHP), Gaborone, Botswana.
HIV Ther. 2009 Sep 1;3(5):501-526. doi: 10.2217/hiv.09.35.
Numerous national public initiatives offering first-line combination antiretroviral therapy (cART) for HIV infection have commenced in sub-Saharan Africa since 2002. Presently, 2.1 million of an estimated seven million Africans in need of cART are receiving treatment. Analyses from the region report favorable clinical/treatment outcomes and impressive declines in AIDS-related mortality among HIV-1-infected adults and children receiving cART. While immunologic recovery, virologic suppression and cART adherence rates are on par with resource-rich settings, loss to follow-up and high mortality rates, especially within the first 6 months of treatment, remain a significant problem. Over the next decade, cART coverage rates are expected to improve across the region, with attendant increases in healthcare utilization for HIV- and non-HIV-related complications and the need for expanded laboratory and clinical services. Planned and in-progress trials will evaluate the use of cART to prevent primary HIV-1 infection with so-called 'test and treat' expansions of coverage and treatment. Education and training programs as well as patient-retention strategies will need to be strengthened as national cART programs are expanded and more people require lifelong monitoring and care.
自2002年以来，撒哈拉以南非洲地区已启动了许多为艾滋病毒感染提供一线联合抗逆转录病毒疗法（cART）的国家公共倡议。目前，估计700万需要cART的非洲人中，有210万人正在接受治疗。该地区的分析报告显示，接受cART的HIV-1感染成人和儿童临床/治疗结果良好，与艾滋病相关的死亡率显著下降。虽然免疫恢复、病毒学抑制和cART依从率与资源丰富地区相当，但失访和高死亡率，尤其是在治疗的前6个月内，仍然是一个重大问题。在未来十年中，预计该地区的cART覆盖率将提高，随之而来的是艾滋病毒和非艾滋病毒相关并发症的医疗保健利用率增加，以及对扩大实验室和临床服务的需求。计划中和正在进行的试验将评估使用cART通过所谓的“检测和治疗”扩大覆盖范围和治疗来预防原发性HIV-1感染。随着国家cART项目的扩大以及越来越多的人需要终身监测和护理，教育和培训项目以及患者保留策略将需要加强。
