Dimitrov Dobromir T, Kiem Hans-Peter, Jerome Keith R, Johnston Christine, Schiffer Joshua T
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Department of Applied Mathematics, University of Washington, Seattle, Washington, USA.
Sci Rep. 2016 Feb 24;6:22183. doi: 10.1038/srep22183.
HIV curative strategies currently under development aim to eradicate latent provirus, or prevent viral replication, progression to AIDS, and transmission. The impact of implementing curative programs on HIV epidemics has not been considered. We developed a mathematical model of heterosexual HIV transmission to evaluate the independent and synergistic impact of ART, HIV prevention interventions and cure on HIV prevalence and incidence. The basic reproduction number was calculated to study the potential for the epidemic to be eliminated. We explored scenarios with and without the assumption that patients enrolled into HIV cure programs need to be on antiretroviral treatment (ART). In our simulations, curative regimes had limited impact on HIV incidence if only ART patients were eligible for cure. Cure implementation had a significant impact on HIV incidence if ART-untreated patients were enrolled directly into cure programs. Concurrent HIV prevention programs moderately decreased the percent of ART treated or cured patients needed to achieve elimination. We project that widespread implementation of HIV cure would decrease HIV prevalence under all scenarios but would only lower rate of new infections if ART-untreated patients were targeted. Current efforts to identify untreated HIV patients will gain even further relevance upon availability of an HIV cure.
目前正在研发的艾滋病治愈策略旨在根除潜伏的前病毒，或防止病毒复制、发展为艾滋病以及传播。尚未考虑实施治愈方案对艾滋病流行的影响。我们建立了一个异性传播艾滋病的数学模型，以评估抗逆转录病毒疗法（ART）、艾滋病预防干预措施和治愈方法对艾滋病流行率和发病率的独立及协同影响。通过计算基本繁殖数来研究消除该流行病的可能性。我们探讨了两种情形，一种假设参与艾滋病治愈方案的患者需要接受抗逆转录病毒治疗（ART），另一种则不做此假设。在我们的模拟中，如果只有接受ART治疗的患者才有资格接受治愈治疗，那么治愈方案对艾滋病发病率的影响有限。如果未接受ART治疗的患者直接纳入治愈方案，那么实施治愈方案对艾滋病发病率有显著影响。同时开展艾滋病预防方案适度降低了实现消除所需的接受ART治疗或治愈患者的比例。我们预计，广泛实施艾滋病治愈方案在所有情形下都会降低艾滋病流行率，但只有针对未接受ART治疗的患者，才能降低新感染率。一旦有了艾滋病治愈方法，目前识别未接受治疗的艾滋病患者的努力将变得更加重要。
