School of Public Policy, University College London.
Dev World Bioeth. 2013 Aug;13(2):57-62. doi: 10.1111/dewb.12021. Epub 2013 Jun 25.
Recent evidence confirming that the administration of antiretroviral drugs (ARVs) to HIV-infected persons may effectively reduce their risk of transmission has revived the discussion about priority setting in the fight against HIV/AIDS. The fact that the very same drugs can be used both for treatment purposes and for preventive purposes (Treatment as Prevention) has been seen as paradigm-shifting and taken to spark a new controversy: In a context of scarce resources, should the allocation of ARVs be prioritized based on the goal of providing treatment, or on the goal of preventing the spread of the HIV epidemic? Contributions to this discussion tend to assume that treatment and prevention constitute two divergent goals that entail conflicting priorities. We challenge that assumption on the basis of both conceptual and empirical examination. We argue that, as far as the provision of ARVs to HIV-infected persons is concerned, the goals of treatment and prevention do not entail conflicting priorities; to the contrary, they dictate converging strategies for the optimal allocation of ARVs. In light of the current evidence, the concept of Treatment as Prevention can indeed be seen as paradigm-shifting, yet in a novel way: Rather than extending the tension between the goals of treatment and prevention to the level of drug-allocation, it dissolves this tension by providing a rationale for a unified strategy for allocating ARVs.
最近的证据证实，对感染艾滋病毒的人进行抗逆转录病毒药物（ARV）治疗可能有效地降低其传播风险，这重新引发了关于艾滋病毒/艾滋病防治工作中优先事项设定的讨论。事实上，同一类药物既可以用于治疗目的，也可以用于预防目的（治疗即预防），这被视为一种范式转变，并引发了新的争议：在资源稀缺的情况下，是否应根据提供治疗的目标，而不是预防艾滋病毒流行的目标，来优先分配 ARV？
对这一讨论的贡献往往假设治疗和预防构成两个不同的目标，需要有冲突的优先事项。我们从概念和经验两个方面对这一假设提出质疑。我们认为，就向艾滋病毒感染者提供 ARV 而言，治疗和预防的目标并不需要相互冲突的优先事项；相反，它们决定了为最佳分配 ARV 而采取的趋同策略。
根据目前的证据，治疗即预防的概念确实可以被视为范式转变，但方式新颖：它并没有将治疗和预防目标之间的紧张关系扩展到药物分配层面，而是通过为统一的 ARV 分配策略提供了一个理由来化解这种紧张关系。
