Bill and Melinda Gates Foundation, Seattle, Washington, USA.
Curr Opin HIV AIDS. 2012 Mar;7(2):157-63. doi: 10.1097/COH.0b013e3283504ab7.
The understanding that antiretroviral treatment prevents HIV transmission through suppression of viral load provides significant new opportunities in HIV prevention. However, knowledge of efficacy is only a first step to having an impact on the spread of HIV at a population level, the ultimate goal of all primary prevention modalities. This review explores what we know about treatment as prevention and how it could be used as a tool, as part of a combination approach, in the global response to HIV.
Efficacy data show that treatment as prevention works at high levels in trial conditions in stable serodiscordant couples; a finding that can reasonably be generalized to other populations at risk of transmitting the virus. Modelling shows that treatment as prevention should have an impact, but the extent of this depends primarily upon whether optimistic or pessimistic assumptions are made about the programmatic use of antiretrovirals (ARVs).
We describe research questions that need to be addressed in developing optimal programmatic public health treatment strategies including how best to target and implement the use of treatment as prevention, how to balance the needs of treatment for the individual patients' clinical benefit against population level benefits, and how to create programmes that are able to link people to and retain them in care.
目的综述：抗逆转录病毒治疗通过抑制病毒载量来预防 HIV 传播，这一认识为 HIV 预防提供了重大的新机遇。然而，对疗效的认识仅仅是对人群层面 HIV 传播产生影响的第一步，这也是所有初级预防手段的最终目标。本文探讨了我们对治疗即预防的了解，以及它如何作为一种工具，作为综合防治方法的一部分，应用于全球的 HIV 应对工作。
最近的发现：疗效数据表明，在稳定的血清学不一致伴侣中，治疗即预防在试验条件下能达到较高的效果；这一发现可以合理地推广到其他有传播病毒风险的人群。模型研究表明，治疗即预防应该会产生影响，但这种影响的程度主要取决于对使用抗逆转录病毒药物（ARV）的方案的假设是乐观还是悲观。
总结：我们描述了在制定最佳的公共卫生治疗策略时需要解决的研究问题，包括如何最好地确定和实施治疗即预防的使用、如何平衡个体患者治疗的临床需求和人群层面的利益、以及如何创建能够将人们联系起来并留住他们接受治疗的方案。
