Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, USA.
Curr Opin HIV AIDS. 2012 Mar;7(2):117-24. doi: 10.1097/COH.0b013e32834fe8ff.
To provide evidence that HIV-1 RNA load can guide treatment-for-prevention interventions to mitigate the HIV epidemic.
Some HIV-infected individuals maintain increased levels of HIV-1 RNA load after acute infection for an extended period of time, and can disproportionately contribute to the spread of HIV in the community. The recent HIV Prevention Trials Network 052 study has demonstrated 96% efficacy for initiation of early antiretroviral treatment (ART) in HIV-1 serodiscordant couples.
The level of HIV-1 RNA load in plasma is the major biological predictor of virus transmission. HIV-infected individuals who maintain increased levels of HIV-1 RNA load, extended high viremics, can transmit virus at higher rates. Combinatorial ART decreases HIV replication, thus reducing rates of virus transmission. Identifying high viremics and placing them on ART seems an attractive strategy that has the potential to achieve both individual benefits by lowering risk for early onset of clinical AIDS and public health benefits by reducing HIV transmission. A key logistical challenge is to screen for high viremics among HIV-positive individuals. Efficacy of the modified treatment-for-prevention approach focused on high viremics is being evaluated in ongoing and upcoming clinical trials. If efficacious, such an approach could be used widely to mitigate and control the HIV epidemic.
为了提供证据表明 HIV-1 RNA 载量可以指导治疗预防干预措施，以减轻 HIV 流行。
一些感染 HIV 的个体在急性感染后很长一段时间内持续保持较高水平的 HIV-1 RNA 载量，并且不成比例地导致社区中 HIV 的传播。最近的 HIV 预防试验网络 052 研究表明，在 HIV-1 血清不一致的夫妇中早期开始抗逆转录病毒治疗（ART）的疗效为 96%。
血浆中 HIV-1 RNA 载量是病毒传播的主要生物学预测因子。持续保持较高 HIV-1 RNA 载量、延长高病毒血症的 HIV 感染者，其病毒传播率更高。联合 ART 可降低 HIV 复制，从而降低病毒传播率。识别高病毒血症并将其置于 ART 治疗下似乎是一种有吸引力的策略，它有可能通过降低早期临床艾滋病发病风险为个体带来益处，并通过减少 HIV 传播为公众健康带来益处。一个关键的后勤挑战是在 HIV 阳性个体中筛选出高病毒血症。正在进行和即将进行的临床试验正在评估针对高病毒血症的改良治疗预防方法的疗效。如果有效，这种方法可以广泛用于减轻和控制 HIV 流行。
