The Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
PLoS Med. 2012;9(7):e1001231. doi: 10.1371/journal.pmed.1001231. Epub 2012 Jul 10.
There is growing enthusiasm for increasing coverage of antiretroviral treatment among HIV-infected people for the purposes of preventing ongoing transmission. Treatment as prevention will face a number of barriers when implemented in real world populations, which will likely lead to the effectiveness of this strategy being lower than proposed by optimistic modelling scenarios or ideal clinical trial settings. Some settings, as part of their prevention and treatment strategies, have already attained rates of HIV testing and use of antiretroviral therapy--with high levels of viral suppression--that many countries would aspire to as targets for a treatment-as-prevention strategy. This review examines a number of these "natural experiments", namely, British Columbia, San Francisco, France, and Australia, to provide commentary on whether treatment as prevention has worked in real world populations. This review suggests that the population-level impact of this strategy is likely to be considerably less than as inferred from ideal conditions.
人们越来越热衷于扩大对 HIV 感染者的抗逆转录病毒治疗覆盖范围，以防止持续传播。在实际人群中实施治疗即预防措施将面临许多障碍，这可能导致该策略的有效性低于乐观模型情景或理想临床试验环境所提出的效果。一些国家已经在其预防和治疗策略中实现了艾滋病毒检测和使用抗逆转录病毒疗法的高比例——病毒载量得到高度抑制——这是许多国家渴望达到的目标，也是治疗即预防策略的目标。本综述考察了一些这样的“自然实验”，即不列颠哥伦比亚省、旧金山、法国和澳大利亚，以评论治疗即预防措施在实际人群中的效果。本综述表明，该策略的人群影响可能远远小于从理想条件推断的结果。
