Buchbinder Susan P, Liu Albert Y
University of California San Francisco and San Francisco Department of Public Health, San Francisco, CA, USA.
Top Antivir Med. 2015 Mar-Apr;23(1):8-27.
HIV testing rates and awareness of HIV serostatus have improved globally, but disparities continue between black and white men who have sex with men (MSM) in the United States, and between women and men globally. The 2015 Conference on Retroviruses and Opportunistic Infections (CROI) was a watershed moment for preexposure prophylaxis (PrEP). Two efficacy trials conducted in MSM were stopped early because of an 86% reduction in the risk of HIV acquisition among men taking tenofovir and emtricitabine. New drugs, long-acting formulations, and different patterns of dosing are undergoing evaluation. Poor adherence has limited PrEP effectiveness in some populations, and new measures of drug levels in dried blood spots and hair appear to be promising new tools. Pharmacokinetic differences of PrEP agents in rectal versus vaginal tissue preclude extrapolating PrEP trial results among MSM to women. Several studies reported no HIV transmissions between HIV-serodiscordant couples when the seropositive partner was successfully treated for 6 months. However, consistent viral suppression does not occur in a substantial minority of patients in many clinics, reducing the potential impact of treatment as prevention.
全球范围内，艾滋病毒检测率及对艾滋病毒血清状态的知晓率均有所提高，但在美国，男男性行为者（MSM）中黑人和白人之间，以及全球范围内女性和男性之间，差异依然存在。2015年逆转录病毒与机会性感染会议（CROI）是暴露前预防（PrEP）的一个分水岭时刻。在男男性行为者中进行的两项疗效试验提前终止，因为服用替诺福韦和恩曲他滨的男性感染艾滋病毒的风险降低了86%。新型药物、长效制剂及不同给药方式正在接受评估。依从性差限制了PrEP在某些人群中的有效性，而干血斑和头发中药物水平的新检测方法似乎是很有前景的新工具。PrEP药物在直肠组织和阴道组织中的药代动力学差异，使得无法将男男性行为者中的PrEP试验结果外推至女性。几项研究报告称，当血清反应阳性的伴侣成功接受6个月治疗时，艾滋病毒血清学不一致的伴侣之间未发生艾滋病毒传播。然而，在许多诊所中，相当一部分患者并未实现持续的病毒抑制，从而降低了治疗作为预防手段的潜在影响。
