National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Darlinghurst, Sydney, NSW, Australia.
AIDS. 2010 Oct 23;24(16):2573-8. doi: 10.1097/QAD.0b013e32833ead96.
The first evidence of modest effectiveness of an HIV vaccine was demonstrated by the RV144 trial in Thailand in 2009. Although promising, this vaccine has largely been dismissed because it only had 30% efficacy. In contrast, male circumcision is widely supported and has approximately twice the efficacy, but can only be targeted to half of the population. We question the vaccine efficacy required before being considered in prevention strategies.
We forecast the expected population-level impact of implementing circumcision among males compared with a 30% effective vaccine among males and females.
A mathematical transmission model was developed to describe the HIV epidemics in two different settings, Thailand and South Africa, and to forecast the expected impact of circumcision or vaccine interventions.
Interventions using a vaccine with 30% efficacy would likely have a greater population benefit than male circumcision because a proportion of males are already circumcised, thus diminishing the potential target population. Both males and females will receive considerable benefit from vaccination (for example, 33% of infections averted for males and 36% for females in South Africa), whereas females will receive only moderate benefit from male circumcision (for example, 47% of infections averted for males and 19% for females in South Africa). In both settings, it would likely take a number of years before the interventions could have a noticeable impact on HIV epidemics.
A moderately effective vaccine, such as the one demonstrated in the RV144 trial, may have a potential role in public health programs.
2009 年，泰国的 RV144 试验首次证明了 HIV 疫苗具有一定的效果。尽管该疫苗有一定的效果，但由于其效力仅为 30%，因此基本上被否定了。相比之下，男性包皮环切术得到了广泛的支持，其效果大约是疫苗的两倍，但只能针对一半的人口。我们质疑在预防策略中考虑使用疫苗所需的效果。
我们预测在男性中实施包皮环切术与在男性和女性中实施 30%有效疫苗相比的预期人群水平影响。
我们开发了一个数学传播模型来描述泰国和南非两个不同环境中的 HIV 流行情况，并预测包皮环切术或疫苗干预的预期影响。
使用 30%有效疫苗的干预措施可能比男性包皮环切术具有更大的人群效益，因为已经有一部分男性接受了包皮环切术，从而减少了潜在的目标人群。男性和女性都将从疫苗接种中获得相当大的益处（例如，在南非，男性可预防 33%的感染，女性可预防 36%的感染），而女性仅从男性包皮环切术获得适度的益处（例如，在南非，男性可预防 47%的感染，女性可预防 19%的感染）。在这两种情况下，干预措施可能需要数年时间才能对 HIV 流行产生明显影响。
一种效果中等的疫苗，如 RV144 试验中所证明的那样，可能在公共卫生计划中发挥作用。
