Brown A E, Gill O N, Delpech V C
HIV and STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control, London, UK.
HIV Med. 2013 Oct;14(9):563-70. doi: 10.1111/hiv.12066. Epub 2013 Jul 28.
In the UK, free HIV care is provided through dedicated HIV clinics. Using the national cohort of men who have sex with men (MSM) with diagnosed HIV infection and estimates of the number of undiagnosed men, we assessed whether high retention in HIV care and treatment coverage is sufficient to reduce HIV transmission.
Antiretroviral therapy (ART) uptake and viral load distribution among diagnosed men were analysed by treatment status and CD4 count for the period between 2006 and 2010. A multi-parameter evidence synthesis (MPES) method was used to estimate the size of the undiagnosed population. The viral load distribution among newly diagnosed untreated men was applied to the undiagnosed population. Infectivity was defined as a viral load > 1500 HIV-1 RNA copies/mL.
Between 2006 and 2010, ART coverage among all HIV-infected MSM (diagnosed and undiagnosed) increased from 49 to 60%, while the proportion of infectious men fell from 47 to 35%. Over the same period, the number of all HIV-infected MSM increased from 30,000 to 40,100 and the number of infectious MSM remained stable at 14,000. Of the 14,000 infectious MSM in 2010, 62% were undiagnosed, 33% were diagnosed but untreated, and 5% received ART. Extending ART to all diagnosed HIV-infected MSM with CD4 counts < 500 cells/μL in 2010 would have reduced the overall proportion of infectious men from 35 to 29% and halving the proportion who were undiagnosed would further have reduced this to 21%.
High ART coverage in the UK has reduced the infectivity of the HIV-diagnosed population. However, the effectiveness of treatment as prevention will be limited unless the undiagnosed population is reduced through frequent HIV testing and consistent condom use.
在英国，免费的艾滋病病毒治疗是通过专门的艾滋病病毒诊所提供的。利用全国男男性行为者（MSM）确诊感染艾滋病病毒的队列以及未确诊男性数量的估计值，我们评估了艾滋病病毒治疗的高留存率和治疗覆盖率是否足以减少艾滋病病毒传播。
分析了2006年至2010年期间确诊男性中抗逆转录病毒疗法（ART）的使用情况和病毒载量分布，按治疗状态和CD4细胞计数进行分析。采用多参数证据综合（MPES）方法估计未确诊人群的规模。将新确诊未治疗男性的病毒载量分布应用于未确诊人群。传染性定义为病毒载量>1500 HIV-1 RNA拷贝/毫升。
2006年至2010年期间，所有感染艾滋病病毒的男男性行为者（确诊和未确诊）的ART覆盖率从49%提高到60%，而具有传染性的男性比例从47%降至35%。同期，所有感染艾滋病病毒的男男性行为者数量从30000人增加到40100人，具有传染性的男男性行为者数量稳定在14000人。在2010年的14000名具有传染性的男男性行为者中，62%未被确诊，33%已确诊但未接受治疗，5%接受了ART治疗。2010年将ART治疗扩展至所有CD4细胞计数<500个/微升的确诊感染艾滋病病毒的男男性行为者，会使具有传染性的男性总体比例从35%降至29%，而将未确诊者比例减半会进一步将其降至21%。
英国高ART覆盖率降低了已确诊艾滋病病毒人群的传染性。然而，除非通过频繁的艾滋病病毒检测和持续使用避孕套减少未确诊人群数量，否则治疗即预防的效果将受到限制。
