Granich Reuben, Gupta Somya, Hersh Bradley, Williams Brian, Montaner Julio, Young Benjamin, Zuniga José M
International Association of Providers of AIDS Care, Washington D.C., United States of America.
Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland.
PLoS One. 2015 Jul 6;10(7):e0131353. doi: 10.1371/journal.pone.0131353. eCollection 2015.
Antiretroviral therapy (ART) prevents human immunodeficiency virus (HIV) disease progression, mortality and transmission. We assess the impact of expanded HIV treatment for the prevention of Acquired Immunodeficiency Syndrome (AIDS)-related deaths and simulate four treatment scenarios for Nigeria and South Africa.
For 1990-2013, we used the Joint United Nations Programme on HIV/AIDS (UNAIDS) database to examine trends in AIDS deaths, HIV incidence and prevalence, ART coverage, annual AIDS death rate, AIDS death-to-treatment and HIV infections to treatment ratios for the top 30 countries with the highest AIDS mortality burden and compare them with data from high-income countries. We projected the 1990-2020 AIDS deaths for Nigeria and South Africa using four treatment scenarios: 1) no ART; 2) maintaining current ART coverage; 3) 90% ART coverage based on 2013 World Health Organization (WHO) ART guidelines by 2020; and 4) reaching the United Nations 90-90-90 Target by 2020.
In 2013, there were 1.3 million (1.1 million-1.6 million) AIDS deaths in the top 30 countries representing 87% of global AIDS deaths. Eight countries accounted for 58% of the global AIDS deaths; Nigeria and South Africa accounted for 27% of global AIDS deaths. The highest death rates per 1000 people living with HIV were in Central African Republic (91), South Sudan (82), Côte d'Ivoire (75), Cameroon (72) and Chad (71), nearly 8-10 times higher than the high-income countries. ART access in 2013 has averted as estimated 1,051,354 and 422,448 deaths in South Africa and Nigeria, respectively. Increasing ART coverage in these two countries to meet the proposed UN 90-90-90 Target by 2020 could avert 2.2 and 1.2 million deaths, respectively.
Over the past decade the expansion of access to ART averted millions of deaths. Reaching the proposed UN 90-90-90 Target by 2020 will prevent additional morbidity, mortality and HIV transmission. Despite progress, high-burden countries will need to accelerate access to ART treatment to avert millions of premature AIDS deaths and new HIV infections.
抗逆转录病毒疗法（ART）可预防人类免疫缺陷病毒（HIV）疾病进展、死亡及传播。我们评估扩大HIV治疗对预防获得性免疫缺陷综合征（AIDS）相关死亡的影响，并针对尼日利亚和南非模拟了四种治疗方案。
对于1990 - 2013年，我们使用联合国艾滋病规划署（UNAIDS）数据库，研究艾滋病死亡率负担最高的30个国家的艾滋病死亡、HIV发病率和患病率、ART覆盖率、年度艾滋病死亡率、艾滋病死亡与治疗比例以及HIV感染与治疗比例的趋势，并将其与高收入国家的数据进行比较。我们使用四种治疗方案预测了尼日利亚和南非1990 - 2020年的艾滋病死亡情况：1）不进行ART治疗；2）维持当前的ART覆盖率；3）到2020年根据2013年世界卫生组织（WHO）的ART指南将ART覆盖率提高到90%；4）到2020年实现联合国90 - 90 - 90目标。
2013年，排名前30的国家中有130万（110万 - 160万）例艾滋病死亡，占全球艾滋病死亡人数的87%。八个国家占全球艾滋病死亡人数的58%；尼日利亚和南非占全球艾滋病死亡人数的27%。每1000名HIV感染者中死亡率最高的是中非共和国（91）、南苏丹（82）、科特迪瓦（75）、喀麦隆（72）和乍得（71），几乎比高收入国家高8 - 10倍。2013年获得ART治疗分别在南非和尼日利亚避免了估计1,051,354例和422,448例死亡。到2020年将这两个国家的ART覆盖率提高以实现提议的联合国90 - 90 - 90目标，可分别避免220万例和120万例死亡。
在过去十年中，扩大ART治疗的可及性避免了数百万例死亡。到2020年实现提议的联合国90 - 90 - 90目标将预防更多的发病、死亡及HIV传播。尽管取得了进展，但高负担国家仍需加快ART治疗的可及性，以避免数百万例过早的艾滋病死亡和新的HIV感染。
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