Faculty of Medicine, Imperial College London, St Mary's Hospital, London, UK.
AIDS. 2010 Oct;24 Suppl 4:S27-39. doi: 10.1097/01.aids.0000390705.73759.2c.
This review considers the use of antiretroviral drugs specifically to prevent HIV transmission. Antiretroviral therapy (ART) can be implemented for the protection of uninfected individuals both before (preexposure prophylaxis) and after (postexposure prophylaxis) exposure to HIV infection. Preexposure prophylaxis may be used coitally dependently when individuals are intermittently exposed or by continuous daily dosing for those constantly exposed; postexposure prophylaxis is used in 28-day courses. Alternatively, ART can be used strategically to reduce the viral load and consequent infectiousness of an HIV-infected individual, thereby limiting the risk of onward viral transmission. A policy of universal HIV testing to enhance the identification of all HIV-positive individuals followed by immediate treatment of all HIV-positive individuals, irrespective of their CD4 cell counts (universal test and treat), has been postulated as a potential tool capable of reducing HIV incidence at a population level. This concept represents a paradigm shift in the use of ART, targeting infectious individuals for prevention rather than protecting uninfected exposed populations. This strategy could have the advantage of preventing transmission and reducing HIV incidence at a population level, as well as delivering universal access to therapy for all people living with HIV and AIDS, potentially eliminating mother-to-child HIV transmission and limiting concomitant diseases such as tuberculosis. This review critically examines the scientific basis of ART for HIV prevention, summarizing the risks and opportunities of the potential expansion of ART for prevention. Specifically, we consider the evidences for and against targeting HIV-uninfected individuals compared with enhanced HIV testing and treatment of HIV-infected individuals in terms of impact on viral transmission.
本综述考虑了专门用于预防 HIV 传播的抗逆转录病毒药物的使用。抗逆转录病毒疗法（ART）可用于保护未感染个体，包括在暴露于 HIV 感染之前（暴露前预防）和之后（暴露后预防）。暴露前预防可以在个体间歇性暴露时依赖性行为使用，也可以对持续暴露的个体进行连续每日剂量使用；暴露后预防则使用 28 天疗程。或者，可以战略性地使用 ART 来降低 HIV 感染者的病毒载量和随之而来的传染性，从而限制病毒传播的风险。普遍进行 HIV 检测以增强对所有 HIV 阳性个体的识别，然后对所有 HIV 阳性个体进行即时治疗，无论其 CD4 细胞计数如何（普遍检测和治疗），这种策略被认为是一种有潜力的工具，可以降低人群中的 HIV 发病率。这种概念代表了 ART 使用的范式转变，将预防的目标指向感染个体，而不是保护未感染的暴露人群。这种策略有可能通过预防传播和降低人群中的 HIV 发病率，以及为所有 HIV 感染者和艾滋病患者提供普遍的治疗机会，从而消除母婴 HIV 传播并限制结核病等同时发生的疾病。本综述批判性地审查了 ART 用于 HIV 预防的科学依据，总结了将 ART 用于预防的潜在扩展的风险和机会。具体而言，我们考虑了针对未感染 HIV 的个体进行干预与加强 HIV 感染者的检测和治疗在病毒传播影响方面的证据。
