University of North Carolina – Social Medicine, 333D MacNider Building, Chapel Hill, NC 27599, USA.
Dev World Bioeth. 2013 Aug;13(2):79-86. doi: 10.1111/dewb.12022. Epub 2013 May 31.
The effectiveness of antiretroviral regimes (ARVs) to reduce risk of HIV transmission from mother to child and as post-exposure prophylaxis has been known for almost two decades. Recent research indicates ARVs can also reduce the risk of HIV transmission via sexual intercourse in two other ways. With pre-exposure prophylaxis (PrEP), ARVs are used to reduce risk of HIV acquisition among persons who are HIV negative and significantly exposed to the virus. With treatment as prevention (TasP), ARVs are used to reduce risk of HIV transmission from persons who are already HIV positive. The development of these new prevention strategies raises a rationing problem: given the chronic shortage of ARVs for HIV-infected persons in need of treatment, is it ethically justified to allocate ARVs for PrEP and/or TasP? This article examines the intuitively appealing view that allocation of ARVs for treatment should be the highest priority, the use of ARVs for TasP should be a secondary priority, and that utilizing ARVs for PrEP would be unethical. I will argue that selective, evidence-based allocation of ARVs for prevention in certain cases could be ethically justified even when there is insufficient anti-retroviral access for all those needing it for treatment.
抗逆转录病毒疗法（ARV）在降低母婴传播和暴露后预防 HIV 风险方面的有效性已为人所知近二十年。最近的研究表明，ARV 还可以通过另外两种方式降低性传播 HIV 的风险。通过暴露前预防（PrEP），ARV 用于降低 HIV 阴性且大量接触病毒的人群感染 HIV 的风险。通过治疗即预防（TasP），ARV 用于降低已经感染 HIV 的人传播 HIV 的风险。这些新的预防策略的发展提出了一个配给问题：鉴于需要治疗的 HIV 感染者慢性缺乏 ARV，将 ARV 分配用于 PrEP 和/或 TasP 在伦理上是否合理？本文考察了一种直观上吸引人的观点，即分配 ARV 用于治疗应是最高优先事项，将 ARV 用于 TasP 应是次要优先事项，而将 ARV 用于 PrEP 在伦理上是不可取的。我将论证，在某些情况下，即使对所有需要 ARV 治疗的人来说，抗逆转录病毒药物的供应都不足，基于选择性和证据的预防用 ARV 分配在伦理上也可能是合理的。
