Williams Brian G, Lima Viviane, Gouws Eleanor
South African Centre for Epidemiological Modelling and Analysis, 19 Jonkershoek Road, Stellenbosch, South Africa.
Curr HIV Res. 2011 Sep;9(6):367-82. doi: 10.2174/157016211798038533.
Thirty years after HIV first appeared it has killed close to 30 million people but transmission continues unchecked. In 2009, an estimated 1.8 million lives were lost and 2.6 million more people were infected with HIV [1]. To cut transmission, many social, behavioural and biomedical interventions have been developed, tested and tried but have had little impact on the epidemic in most countries. One substantial success has been the development of combination antiretroviral therapy (ART) that reduces viral load and restores immune function. This raises the possibility of using ART not only to treat people but also to prevent new HIV infections. Here we consider the impact of ART on the transmission of HIV and show how it could help to control the epidemic. Much needs to be known and understood concerning the impact of early treatment with ART on the prognosis for individual patients and on transmission. We review the current literature on factors associated with modelling treatment for prevention and illustrate the potential impact using existing models. We focus on generalized epidemics in sub- Saharan Africa, with an emphasis on South Africa, where transmission is mainly heterosexual and which account for an estimated 17% of all people living with HIV. We also make reference to epidemics among men who have sex with men and injection drug users where appropriate. We discuss ways in which using treatment as prevention can be taken forward knowing that this can only be the beginning of what must become an inclusive dialogue among all of those concerned to stop acquired immune deficiency syndrome (AIDS).
在艾滋病病毒首次出现30年后，它已导致近3000万人死亡，但传播仍未得到控制。2009年，估计有180万人丧生，另有260万人感染了艾滋病病毒[1]。为了减少传播，人们开发、测试并尝试了许多社会、行为和生物医学干预措施，但在大多数国家，这些措施对疫情几乎没有影响。一个重大成功是联合抗逆转录病毒疗法（ART）的开发，该疗法可降低病毒载量并恢复免疫功能。这增加了不仅使用ART治疗患者，还预防新的艾滋病病毒感染的可能性。在此，我们考虑ART对艾滋病病毒传播的影响，并展示它如何有助于控制疫情。关于早期使用ART治疗对个体患者预后和传播的影响，还有很多需要了解和认识的。我们回顾了当前关于与预防治疗建模相关因素的文献，并使用现有模型说明了潜在影响。我们关注撒哈拉以南非洲的广泛疫情，重点是南非，那里的传播主要是异性传播，估计占所有艾滋病病毒感染者的17%。在适当的情况下，我们还会提及男男性行为者和注射吸毒者中的疫情。我们讨论了如何推进将治疗作为预防手段的做法，因为我们知道这仅仅是所有相关方为阻止获得性免疫缺陷综合征（艾滋病）而进行的包容性对话的开始。
