人类免疫缺陷病毒治疗作为个体和群体层面预防措施的基本原理及证据

Rationale and evidence for human immunodeficiency virus treatment as prevention at the individual and population levels.

作者信息

Hoffmann Christopher J, Gallant Joel E

机构信息

Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 725 North Wolfe Street, Room 226, Baltimore, MD 21205, USA.

Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 725 North Wolfe Street, Room 226, Baltimore, MD 21205, USA; Department of Specialty Services, Southwest CARE Center, 649 Harkle Road, Suite E, Sante Fe, NM 87505, USA.

出版信息

Infect Dis Clin North Am. 2014 Dec;28(4):549-61. doi: 10.1016/j.idc.2014.08.003. Epub 2014 Oct 5.

DOI:10.1016/j.idc.2014.08.003

PMID:25287588

Abstract

Individual health benefits of antiretroviral therapy (ART) are becoming clearer. In resource-rich countries, side effects of current ART regimens are minimal. US guidelines recommend ART regardless of CD4 count or viral load. Maintaining an undetectable viral load with ART comes close to eliminating the risk of HIV transmission, leading the US guidelines to recommend universal ART to reduce HIV transmission. Achieving population-level control through treatment as prevention (TasP) may be feasible, but requires considerable investment of resources devoted to HIV testing, linkage to care, ART accessibility, and retention in care. Ongoing studies of TasP will provide insight into achieving meaningful ART coverage.

摘要

抗逆转录病毒疗法（ART）对个体健康的益处正日益明晰。在资源丰富的国家，当前抗逆转录病毒疗法方案的副作用极小。美国指南建议无论CD4细胞计数或病毒载量如何都应进行抗逆转录病毒疗法。通过抗逆转录病毒疗法维持不可检测的病毒载量几乎可以消除艾滋病毒传播的风险，这使得美国指南建议采用普遍抗逆转录病毒疗法以减少艾滋病毒传播。通过治疗即预防（TasP）实现人群层面的控制可能是可行的，但需要投入大量资源用于艾滋病毒检测、与护理的联系、抗逆转录病毒疗法的可及性以及护理的持续性。正在进行的治疗即预防研究将为实现有意义的抗逆转录病毒疗法覆盖范围提供见解。