Department of HIV/AIDS, World Health Organization, Geneva, Switzerland.
J Int AIDS Soc. 2010 Jan 12;13:1. doi: 10.1186/1758-2652-13-1.
In 2007 an estimated 33 million people were living with HIV; 67% resided in sub-Saharan Africa, with 35% in eight countries alone. In 2007, there were about 1.4 million HIV-positive tuberculosis cases. Globally, approximately 4 million people had been given highly active antiretroviral therapy (HAART) by the end of 2008, but in 2007, an estimated 6.7 million were still in need of HAART and 2.7 million more became infected with HIV.Although there has been unprecedented investment in confronting HIV/AIDS - the Joint United Nations Programme on HIV/AIDS estimates $13.8 billion was spent in 2008 - a key challenge is how to address the HIV/AIDS epidemic given limited and potentially shrinking resources. Economic disparities may further exacerbate human rights issues and widen the increasingly divergent approaches to HIV prevention, care and treatment.HIV transmission only occurs from people with HIV, and viral load is the single greatest risk factor for all modes of transmission. HAART can lower viral load to nearly undetectable levels. Prevention of mother to child transmission offers proof of the concept of HAART interrupting transmission, and observational studies and previous modelling work support using HAART for prevention. Although knowing one's HIV status is key for prevention efforts, it is not known with certainty when to start HAART.Building on previous modelling work, we used an HIV/AIDS epidemic of South African intensity to explore the impact of testing all adults annually and starting persons on HAART immediately after they are diagnosed as HIV positive. This theoretical strategy would reduce annual HIV incidence and mortality to less than one case per 1000 people within 10 years and it would reduce the prevalence of HIV to less than 1% within 50 years. To explore HAART as a prevention strategy, we recommend further discussions to explore human rights and ethical considerations, clarify research priorities and review feasibility and acceptability issues.
2007 年，估计有 3300 万人感染艾滋病毒；其中 67%生活在撒哈拉以南非洲，仅 8 个国家就有 35%。2007 年，艾滋病毒阳性结核病病例约有 140 万例。到 2008 年底，全球约有 400 万人接受了高效抗逆转录病毒治疗（HAART），但 2007 年仍有估计 670 万人需要 HAART，另有 270 万人新感染艾滋病毒。尽管在应对艾滋病毒/艾滋病方面投入了前所未有的资金——联合国艾滋病毒/艾滋病联合规划署估计 2008 年支出 138 亿美元——但一个关键挑战是如何在资源有限且可能减少的情况下应对艾滋病毒/艾滋病疫情。经济差距可能会进一步加剧人权问题，并扩大在艾滋病毒预防、护理和治疗方面日益分歧的方法。艾滋病毒传播仅发生在艾滋病毒感染者身上，病毒载量是所有传播方式的最大单一风险因素。高效抗逆转录病毒治疗可以将病毒载量降低到几乎无法检测的水平。母婴传播预防提供了高效抗逆转录病毒治疗中断传播这一概念的证据，观察性研究和以前的建模工作支持将高效抗逆转录病毒治疗用于预防。尽管了解一个人的艾滋病毒状况是预防工作的关键，但尚不确定何时开始高效抗逆转录病毒治疗。在以前的建模工作的基础上，我们使用南非强度的艾滋病毒/艾滋病流行情况来探索每年对所有成年人进行检测并在他们被诊断为艾滋病毒阳性后立即开始对他们进行高效抗逆转录病毒治疗的影响。这种理论策略将在 10 年内将每年艾滋病毒发病率和死亡率降低到每 1000 人不到 1 例，并在 50 年内将艾滋病毒流行率降低到不到 1%。为了探索高效抗逆转录病毒治疗作为一种预防策略，我们建议进一步讨论，以探讨人权和伦理问题，澄清研究重点，并审查可行性和可接受性问题。
