Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS One. 2012;7(2):e29098. doi: 10.1371/journal.pone.0029098. Epub 2012 Feb 10.
Early diagnosis and treatment of HIV infection and suppression of viral load are potentially powerful interventions for reducing HIV incidence. A test-and-treat strategy may have long-term effects on the epidemic among urban men who have sex with men (MSM) in the United States and may achieve the 5-year goals of the 2010 National AIDS Strategy that include: 1) lowering to 25% the annual number of new infections, 2) reducing by 30% the HIV transmission rate, 3) increasing to 90% the proportion of persons living with HIV infection who know their HIV status, 4) increasing to 85% the proportion of newly diagnosed patients linked to clinical care, and 5) increasing by 20% the proportion of HIV-infected MSM with an undetectable HIV RNA viral load.
We constructed a dynamic compartmental model among MSM in an urban population (based on New York City) that projects new HIV infections over time. We compared the cumulative number of HIV infections in 20 years, assuming current annual testing rate and treatment practices, with new infections after improvements in the annual HIV testing rate, notification of test results, linkage to care, initiation of antiretroviral therapy (ART) and viral load suppression. We also assessed whether five of the national HIV prevention goals could be met by the year 2015. Over a 20-year period, improvements in test-and-treat practice decreased the cumulative number of new infections by a predicted 39.3% to 69.1% in the urban population based on New York City. Institution of intermediate improvements in services would be predicted to meet at least four of the five goals of the National HIV/AIDS Strategy by the 2015 target.
Improving the five components of a test-and-treat strategy could substantially reduce HIV incidence among urban MSM, and meet most of the five goals of the National HIV/AIDS Strategy.
早期诊断和治疗 HIV 感染并抑制病毒载量是减少 HIV 发病率的潜在有力干预措施。检测和治疗策略可能会对美国城市男男性行为者（MSM）中的艾滋病流行产生长期影响，并可能实现 2010 年《国家艾滋病战略》的 5 年目标，包括：1）将每年新感染人数降低 25%，2）将 HIV 传播率降低 30%，3）将 HIV 感染者中知晓其 HIV 状况的比例提高到 90%，4）将新诊断患者与临床护理联系起来的比例提高到 85%，以及 5）将 HIV 感染的 MSM 中 HIV RNA 病毒载量不可检测的比例提高 20%。
我们在城市人群（基于纽约市）中的 MSM 中构建了一个动态房室模型，该模型预测了随时间推移的新 HIV 感染。我们比较了在当前每年的检测率和治疗实践假设下，在改善每年 HIV 检测率、通知检测结果、与护理联系、开始抗逆转录病毒治疗（ART）和病毒载量抑制后，20 年内新感染的累积数量。我们还评估了到 2015 年是否可以实现五个国家艾滋病预防目标。在 20 年的时间里，检测和治疗实践的改善预计将使基于纽约市的城市人群中新感染的累积数量减少 39.3%至 69.1%。预计中间改善服务将至少满足《国家艾滋病战略》五个目标中的四个目标。
改善检测和治疗策略的五个组成部分可以大大降低城市 MSM 中的 HIV 发病率，并满足《国家艾滋病战略》的大部分目标。
