Granich Reuben, Gupta Somya, Suthar Amitabh B, Smyth Caoimhe, Hoos David, Vitoria Marco, Simao Mariangela, Hankins Catherine, Schwartlander Bernard, Ridzon Renee, Bazin Brigitte, Williams Brian, Lo Ying-Ru, McClure Craig, Montaner Julio, Hirnschall Gottfried
Antiretroviral Treatment and HIV Care, Department of HIV/AIDS, Building D, 1st Floor, Room 1005, World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland.
Curr HIV Res. 2011 Sep;9(6):446-69. doi: 10.2174/157016211798038597.
There is considerable scientific evidence supporting the use of antiretroviral therapy (ART) in prevention of human immunodeficiency virus (HIV) and tuberculosis (TB) infections. The complex nature of the HIV and TB prevention responses, resource constraints, remaining questions about cost and feasibility, and the need to use a solid evidence base to make policy decisions, and the implementation challenges to translating trial data to operational settings require a well-organised and coordinated response to research in this area. To this end, we aimed to catalogue the ongoing and planned research activities that evaluate the impact of ART plus other interventions on HIV- and/or TB-related morbidity, mortality, risk behaviour, HIV incidence and transmission. Using a limited search methodology, 50 projects were identified examining ART as prevention, representing 5 regions and 52 countries with a global distribution. There are 24 randomised controlled clinical trials with at least 12 large randomised individual or community cluster trials in resource-constrained settings that are in the planning or early implementation stages. There is considerable heterogeneity between studies in terms of methodology, interventions and geographical location. While the identified studies will undoubtedly advance our understanding of the efficacy and effectiveness of ART for prevention, some key questions may remain unanswered or only partially answered. The large number and wide variety of research projects emphasise the importance of this research issue and clearly demonstrate the potential for synergies, partnerships and coordination across funding agencies.
有大量科学证据支持使用抗逆转录病毒疗法（ART）预防人类免疫缺陷病毒（HIV）和结核病（TB）感染。HIV和TB预防应对措施的复杂性、资源限制、关于成本和可行性的遗留问题、利用坚实证据基础做出政策决策的必要性，以及将试验数据转化为实际应用环境的实施挑战，都需要对该领域的研究做出精心组织和协调的回应。为此，我们旨在梳理正在进行和计划开展的研究活动，这些活动评估了ART联合其他干预措施对HIV和/或TB相关发病率、死亡率、风险行为、HIV发病率及传播的影响。采用有限的检索方法，共识别出50个将ART作为预防手段的研究项目，分布于全球5个地区的52个国家。有24项随机对照临床试验，在资源受限环境中至少有12项大型随机个体或社区群组试验正处于规划或早期实施阶段。各研究在方法、干预措施和地理位置方面存在相当大的异质性。虽然已识别出的研究无疑将增进我们对ART预防效果和有效性的理解，但一些关键问题可能仍未得到解答或仅得到部分解答。大量且多样的研究项目凸显了这一研究问题的重要性，并清楚表明了各资助机构之间协同合作及协调的潜力。
