Research Department of Infection and Population Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
Euro Surveill. 2013 Nov 28;18(48):20647. doi: 10.2807/1560-7917.es2013.18.48.20647.
The aim of this review is to summarise the evidence on the population-level effect of antiretroviral therapy (ART) in preventing HIV infections, and to discuss potential implications in the European context of recommending starting ART when the CD4 count is above 350 cells/mm3. The ability of ART to reduce the risk of HIV transmission has been reported in observational studies and in a randomised controlled trial (HPTN 052), in which ART initiation reduced HIV transmission by 96% within serodiscordant couples. As yet, there is no direct evidence for such an effect among men having sex with men or people who inject drugs. HPTN 052 led international organisations to develop recommendations with a higher CD4 threshold for ART initiation. However, there remains a lack of strong evidence of clinical benefit for HIV-positive individuals starting ART with CD4 count above 350 cells/mm3. The main goal of ART provision should be to increase ART coverage for all those in need, based on the current guidelines, and the offer of ART to those who wish to reduce infectivity; increased HIV testing is therefore a key requirement. Other proven prevention means such as condom use and harm reduction for people who inject drugs remain critical.
本综述旨在总结抗逆转录病毒疗法（ART）在预防 HIV 感染方面的人群效果证据，并讨论在建议当 CD4 计数高于 350 个细胞/mm3 时开始 ART 的情况下，这在欧洲背景下可能产生的影响。ART 降低 HIV 传播风险的能力已在观察性研究和一项随机对照试验（HPTN 052）中得到证实，在该试验中，在血清不一致的夫妇中，ART 起始使 HIV 传播降低了 96%。然而，目前尚无直接证据表明这种效果在男男性行为者或注射毒品者中存在。HPTN 052 促使国际组织制定了更高的 CD4 阈值用于启动 ART 的建议。然而，对于 CD4 计数高于 350 个细胞/mm3 的 HIV 阳性个体开始 ART 是否具有临床益处，仍缺乏强有力的证据。ART 供应的主要目标应该是根据当前指南，为所有有需要的人增加 ART 的覆盖率，并为那些希望降低传染性的人提供 ART；因此，增加 HIV 检测是关键要求。其他经证实的预防措施，如安全套的使用和对注射毒品者的减少伤害，仍然至关重要。
