撒哈拉以南非洲地区成年人到 2030 年需要二线抗逆转录病毒治疗：一项数学建模研究。
The need for second-line antiretroviral therapy in adults in sub-Saharan Africa up to 2030: a mathematical modelling study.
机构信息
University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland.
World Health Organization, Department of HIV/AIDS, Geneva, Switzerland.
出版信息
Lancet HIV. 2016 Mar;3(3):e132-9. doi: 10.1016/S2352-3018(16)00016-3. Epub 2016 Feb 16.
BACKGROUND
The number of patients in need of second-line antiretroviral drugs is increasing in sub-Saharan Africa. We aimed to project the need of second-line antiretroviral therapy in adults in sub-Saharan Africa up to 2030.
METHODS
We developed a simulation model for HIV and applied it to each sub-Saharan African country. We used the WHO country intelligence database to estimate the number of adult patients receiving antiretroviral therapy from 2005 to 2014. We fitted the number of adult patients receiving antiretroviral therapy to observed estimates, and predicted first-line and second-line needs between 2015 and 2030. We present results for sub-Saharan Africa, and eight selected countries. We present 18 scenarios, combining the availability of viral load monitoring, speed of antiretroviral scale-up, and rates of retention and switching to second-line. HIV transmission was not included.
FINDINGS
Depending on the scenario, 8·7-25·6 million people are expected to receive antiretroviral therapy in 2020, of whom 0·5-3·0 million will be receiving second-line antiretroviral therapy. The proportion of patients on treatment receiving second-line therapy was highest (15·6%) in the scenario with perfect retention and immediate switching, no further scale-up, and universal routine viral load monitoring. In 2030, the estimated range of patients receiving antiretroviral therapy will remain constant, but the number of patients receiving second-line antiretroviral therapy will increase to 0·8-4·6 million (6·6-19·6%). The need for second-line antiretroviral therapy was two to three times higher if routine viral load monitoring was implemented throughout the region, compared with a scenario of no further viral load monitoring scale-up. For each monitoring strategy, the future proportion of patients receiving second-line antiretroviral therapy differed only minimally between countries.
INTERPRETATION
Donors and countries in sub-Saharan Africa should prepare for a substantial increase in the need for second-line drugs during the next few years as access to viral load monitoring improves. An urgent need exists to decrease the costs of second-line drugs.
FUNDING
World Health Organization, Swiss National Science Foundation, National Institutes of Health.
背景
在撒哈拉以南非洲，需要二线抗逆转录病毒药物的患者人数正在增加。我们旨在预测 2030 年之前撒哈拉以南非洲成年人对二线抗逆转录病毒治疗的需求。
方法
我们开发了一种 HIV 模拟模型，并将其应用于每个撒哈拉以南非洲国家。我们使用世界卫生组织国家情报数据库来估计 2005 年至 2014 年接受抗逆转录病毒治疗的成年患者人数。我们将接受抗逆转录病毒治疗的成年患者人数拟合到观察到的估计值，并预测 2015 年至 2030 年之间的一线和二线需求。我们展示了撒哈拉以南非洲和八个选定国家的结果。我们提出了 18 种情景，结合了病毒载量监测的可用性、抗逆转录病毒扩大的速度以及保留率和转向二线治疗的速度。未包括 HIV 传播。
结果
根据情景的不同，预计 2020 年将有 870 万至 2560 万人接受抗逆转录病毒治疗，其中 50 万至 300 万人将接受二线抗逆转录病毒治疗。在保留率为完美且立即切换、不再扩大规模以及常规病毒载量监测的情景下，接受治疗的患者中接受二线治疗的比例最高（15.6%）。到 2030 年，接受抗逆转录病毒治疗的患者估计范围将保持不变，但接受二线抗逆转录病毒治疗的患者人数将增加到 80 万至 460 万（660 万至 1960 万）。与不进一步扩大病毒载量监测的情景相比，如果在整个地区实施常规病毒载量监测，对二线抗逆转录病毒药物的需求将增加两到三倍。对于每种监测策略，在不同国家，接受二线抗逆转录病毒治疗的患者未来比例差异仅略有不同。
解释
随着病毒载量监测的改善，撒哈拉以南非洲的捐助者和国家应该为未来几年二线药物需求的大幅增加做好准备。迫切需要降低二线药物的成本。
资金
世界卫生组织、瑞士国家科学基金会、美国国立卫生研究院。
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