抗逆转录病毒疗法用于预防HIV传播：需要具备哪些条件？
Antiretroviral therapy for the prevention of HIV transmission: what will it take?
作者信息
McNairy Margaret L, El-Sadr Wafaa M
机构信息
Mailman School of Public Health, ICAP at Columbia University.
出版信息
Clin Infect Dis. 2014 Apr;58(7):1003-11. doi: 10.1093/cid/ciu018. Epub 2014 Jan 14.
Abstract
The evidence in support of use of antiretroviral therapy (ART) for prevention of human immunodeficiency virus (HIV) transmission is encouraging and has stimulated optimism for achieving a dramatic change in the trajectory of the HIV epidemic. Yet, there are substantial challenges that, if not addressed, could be the Achilles' heel for this concept. These challenges require strengthening every step of the HIV care continuum, including expansion of HIV testing to reach all those with HIV infection, effective linkage to and retention in care, timely initiation of ART, and high levels of treatment adherence with viral load suppression. Also important is the identification of individuals with acute HIV infection whose contribution to HIV transmission may be substantial. Implementation research is needed to identify strategies that address these challenges and to determine the efficacy of ART for prevention in key populations as well as to evaluate the effectiveness of combination strategies for HIV prevention at the population level.
摘要
支持使用抗逆转录病毒疗法（ART）预防人类免疫缺陷病毒（HIV）传播的证据令人鼓舞，并激发了人们对在HIV流行趋势上实现巨大转变的乐观情绪。然而，仍存在重大挑战，如果不加以解决，可能会成为这一理念的致命弱点。这些挑战要求加强HIV护理连续过程的每一步，包括扩大HIV检测以覆盖所有HIV感染者，有效转诊并持续接受护理，及时开始ART治疗，以及在病毒载量得到抑制的情况下保持高水平的治疗依从性。识别急性HIV感染者也很重要，他们对HIV传播的贡献可能很大。需要开展实施研究，以确定应对这些挑战的策略，确定ART在关键人群中的预防效果，并评估HIV预防组合策略在人群层面的有效性。
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