Granich Reuben, Lo Ying-Ru, Suthar Amitabh B, Vitoria Marco, Baggaley Rachel, Obermeyer Carla Makhlouf, McClure Craig, Souteyrand Yves, Perriens Jos, Kahn James G, Bennett Rod, Smyth Caoimhe, Williams Brian, Montaner Julio, Hirnschall Gottfried
Antiretroviral Treatment and HIV Care Unit, Department of HIV/AIDS, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland.
Curr HIV Res. 2011 Sep;9(6):355-66. doi: 10.2174/157016211798038551.
After 30 years we are still struggling to address a devastating HIV pandemic in which over 25 million people have died. In 2010, an estimated 34 million people were living with HIV, around 70% of whom live in sub-Saharan Africa. Furthermore, in 2009 there were an estimated 1.2 million new HIV-associated TB cases, and tuberculosis (TB) accounted for 24% of HIV-related deaths. By the end of 2010, 6.6 million people were taking antiretroviral therapy (ART), around 42% of those in need as defined by the 2010 World Health Organization (WHO) guidelines. Despite this achievement, around 9 million people were eligible and still in need of treatment, and new infections (approximately 2.6 million in 2010 alone) continue to add to the future caseload. This combined with the international fiscal crisis has led to a growing concern regarding weakening of the international commitment to universal access and delivery of the Millennium Development Goals by 2015. The recently launched UNAIDS/WHO Treatment 2.0 platform calls for accelerated simplification of ART, in line with a public health approach, to achieve and sustain universal access to ART, including maximizing the HIV and TB preventive benefit of ART by treating people earlier, in line with WHO 2010 normative guidance. The potential individual and public health prevention benefits of using treatment in the prevention of HIV and TB enhance the value of the universal access pledge from a life-saving initiative, to a strategic investment aimed at ending the HIV epidemic. This review analyzes the gaps and summarizes the evidence regarding ART in the prevention of HIV and TB.
30年过去了，我们仍在努力应对毁灭性的艾滋病疫情，已有超过2500万人死于该疾病。2010年，估计有3400万人感染艾滋病毒，其中约70%生活在撒哈拉以南非洲。此外，2009年估计有120万新增艾滋病毒相关结核病病例，结核病占艾滋病毒相关死亡人数的24%。到2010年底，660万人正在接受抗逆转录病毒治疗（ART），约占2010年世界卫生组织（WHO）指南所定义的有需要者的42%。尽管取得了这一成就，但仍有大约900万人符合治疗条件且仍需要治疗，新感染病例（仅2010年就约有260万）继续增加未来的病例负担。这与国际财政危机相结合，导致人们越来越担心到2015年实现千年发展目标的普遍获取和交付的国际承诺会受到削弱。最近启动的联合国艾滋病规划署/世界卫生组织治疗2.0平台呼吁按照公共卫生方法加速简化抗逆转录病毒治疗，以实现并维持抗逆转录病毒治疗的普遍可及性，包括根据世界卫生组织2010年规范性指南，通过更早治疗来最大化抗逆转录病毒治疗对艾滋病毒和结核病的预防效益。在预防艾滋病毒和结核病方面使用治疗方法对个人和公共卫生的潜在预防效益，将普遍获取承诺的价值从一项拯救生命的举措提升为一项旨在终结艾滋病毒流行的战略投资。本综述分析了差距并总结了关于抗逆转录病毒治疗在预防艾滋病毒和结核病方面的证据。
