Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom.
PLoS Med. 2011 Nov;8(11):e1001123. doi: 10.1371/journal.pmed.1001123. Epub 2011 Nov 15.
Antiretrovirals have substantial promise for HIV-1 prevention, either as antiretroviral treatment (ART) for HIV-1-infected persons to reduce infectiousness, or as pre-exposure prophylaxis (PrEP) for HIV-1-uninfected persons to reduce the possibility of infection with HIV-1. HIV-1 serodiscordant couples in long-term partnerships (one member is infected and the other is uninfected) are a priority for prevention interventions. Earlier ART and PrEP might both reduce HIV-1 transmission in this group, but the merits and synergies of these different approaches have not been analyzed.
We constructed a mathematical model to examine the impact and cost-effectiveness of different strategies, including earlier initiation of ART and/or PrEP, for HIV-1 prevention for serodiscordant couples. Although the cost of PrEP is high, the cost per infection averted is significantly offset by future savings in lifelong treatment, especially among couples with multiple partners, low condom use, and a high risk of transmission. In some situations, highly effective PrEP could be cost-saving overall. To keep couples alive and without a new infection, providing PrEP to the uninfected partner could be at least as cost-effective as initiating ART earlier in the infected partner, if the annual cost of PrEP is <40% of the annual cost of ART and PrEP is >70% effective.
Strategic use of PrEP and ART could substantially and cost-effectively reduce HIV-1 transmission in HIV-1 serodiscordant couples. New and forthcoming data on the efficacy of PrEP, the cost of delivery of ART and PrEP, and couples behaviours and preferences will be critical for optimizing the use of antiretrovirals for HIV-1 prevention. Please see later in the article for the Editors' Summary.
抗逆转录病毒药物在 HIV-1 预防方面具有很大的潜力，无论是作为治疗 HIV-1 感染者的抗逆转录病毒治疗（ART）以降低传染性，还是作为未感染 HIV-1 的人使用的暴露前预防（PrEP）以降低感染 HIV-1 的可能性。长期伴侣关系中的 HIV-1 血清不一致的夫妇（一方感染，另一方未感染）是预防干预的重点。早期开始 ART 和 PrEP 都可能减少这组人群中的 HIV-1 传播，但这些不同方法的优缺点和协同作用尚未进行分析。
我们构建了一个数学模型，以研究不同策略对 HIV-1 血清不一致夫妇的预防的影响和成本效益，包括早期开始 ART 和/或 PrEP。尽管 PrEP 的成本很高，但通过未来节省终身治疗费用，特别是在有多个性伴侣、低避孕套使用率和高传播风险的夫妇中，每避免一次感染的成本就会显著降低。在某些情况下，高效的 PrEP 可能会总体上节省成本。为了让夫妇保持活着且没有新的感染，为未感染的伴侣提供 PrEP 可能至少与更早开始感染伴侣的 ART 一样具有成本效益，如果 PrEP 的年成本低于 ART 和 PrEP 的年成本的 40%，且 PrEP 的有效率大于 70%。
战略性地使用 PrEP 和 ART 可以大大降低 HIV-1 血清不一致的夫妇中的 HIV-1 传播。关于 PrEP 的疗效、ART 和 PrEP 的提供成本以及夫妇行为和偏好的新数据和即将到来的数据对于优化抗逆转录病毒药物在 HIV-1 预防中的使用至关重要。请在文章后面查看编辑摘要。
