GUM HIV, HIV Clinical Trials Unit, Imperial College London, London, UK.
Curr Opin HIV AIDS. 2010 Jul;5(4):283-90. doi: 10.1097/COH.0b013e32833a6b11.
This review will discuss the role of antiretroviral therapy to treat primary HIV infection (PHI) as a strategy to prevent onward viral transmission.
Novel technology has greatly enhanced the appreciation of the characteristics of recently transmitted HIV-1 variants. Recent primate data demonstrate marked enhanced infectiousness of viral variants isolated from acutely infected macaques compared with viruses isolated from animals in the chronic phase of disease. These data are supported by phylogenetic analyses of recently transmitted cases in humans, implying that individuals with PHI may contribute disproportionately to onward transmission at a population level.
In the absence of randomized clinical trial data supporting individual benefit of antiretroviral therapy, targeting and treating individuals with PHI as a public health intervention strategy represent a paradigm shift from current treatment strategies based around proven individual benefit alone. However, there is increasing evidence that PHI contributes disproportionately to viral transmission at a population level and failure to incorporate the potential role PHI plays, particularly in focused epidemics, maybe a naïve omission of many of the current mathematical models evaluating the impact of universal test and treat on population-level HIV incidence.
本文将讨论抗逆转录病毒疗法在治疗原发性 HIV 感染（PHI）中的作用，将其作为预防病毒传播的策略。
新的技术极大地提高了对新近传播的 HIV-1 变异体特征的认识。最近的灵长类动物数据表明，与从疾病慢性期动物中分离出的病毒相比，从急性感染猕猴中分离出的病毒具有明显增强的传染性。这些数据得到了人类近期传播病例的系统发育分析的支持，这意味着 PHI 个体可能在人群水平上不成比例地导致病毒传播。
在缺乏支持抗逆转录病毒治疗对个体有益的随机临床试验数据的情况下，将 PHI 个体作为公共卫生干预策略进行针对性治疗和治疗，代表着从目前仅基于个体受益的治疗策略的范式转变。然而，越来越多的证据表明，PHI 在人群水平上不成比例地导致病毒传播，如果不考虑 PHI 可能发挥的作用，特别是在集中流行的情况下，可能会对目前评估普遍检测和治疗对人群 HIV 发病率影响的许多数学模型造成一种幼稚的遗漏。
