阿片类药物替代疗法对注射吸毒者抗逆转录病毒疗法预防艾滋病病毒效果的影响。
Impact of opioid substitution therapy on the HIV prevention benefit of antiretroviral therapy for people who inject drugs.
作者信息
Mukandavire Christinah, Low Andrea, Mburu Gitau, Trickey Adam, May Margaret T, Davies Charlotte F, French Clare E, Looker Katharine J, Rhodes Tim, Platt Lucy, Guise Andy, Hickman Matthew, Vickerman Peter
机构信息
aSchool of Social and Community Medicine, University of Bristol, Bristol bInternational HIV/AIDS Alliance, Brighton cDivision of Health Research, Lancaster University, Lancaster, Lancashire dLondon School of Hygiene and Tropical Medicine, London, UK.
出版信息
AIDS. 2017 May 15;31(8):1181-1190. doi: 10.1097/QAD.0000000000001458.
OBJECTIVE
A recent meta-analysis suggested that opioid substitution therapy (OST) increased uptake of antiretroviral treatment (ART) and HIV viral suppression. We modelled whether OST could improve the HIV prevention benefit achieved by ART among people who inject drugs (PWID).
METHODS
We modelled how introducing OST could improve the coverage of ART across a PWID population for different baseline ART coverage levels. Using existing data on how yearly HIV-transmission risk is related to HIV plasma viral load, changes in the level of viral suppression across the population were used to project the relative reduction in yearly HIV-transmission risk achieved by ART, with or without OST, compared with if there was no ART - defined here as the prevention effectiveness of ART.
RESULTS
Owing to OST use increasing the chance of being on ART and achieving viral suppression if on ART, the prevention effectiveness of ART for PWID on OST (compared with PWID not on OST) increases by 44, 31, or 20% for a low (20%), moderate (40%), or high (60%) baseline ART coverage, respectively. Improvements in the population-level prevention effectiveness of ART are also achieved across all PWID, compared with if OST was not introduced. For instance, if OST is introduced at 40% coverage, the population-level prevention effectiveness of ART could increase by 27, 20, or 13% for a low (20%), moderate (40%), or high (60%) baseline ART coverage, respectively.
CONCLUSION
OST could improve the HIV prevention benefit of ART; supporting strategies that aim to concurrently scale-up OST with ART.
目的
最近的一项荟萃分析表明，阿片类药物替代疗法（OST）可提高抗逆转录病毒治疗（ART）的使用率及HIV病毒抑制率。我们建立模型，以探讨OST是否能改善注射吸毒者（PWID）中ART带来的HIV预防效益。
方法
我们建立模型，以研究引入OST如何在不同的基线ART覆盖率水平下提高PWID群体中ART的覆盖率。利用现有的关于年度HIV传播风险与HIV血浆病毒载量之间关系的数据，通过人群中病毒抑制水平的变化来预测在有或没有OST的情况下，与没有ART（此处定义为ART的预防效果）相比，ART实现的年度HIV传播风险的相对降低。
结果
由于使用OST增加了接受ART治疗并在接受ART治疗时实现病毒抑制的机会，对于低（20%）、中（40%）或高（60%）基线ART覆盖率，接受OST的PWID中ART的预防效果（与未接受OST的PWID相比）分别提高44%、31%或20%。与未引入OST相比，在所有PWID中，ART在人群水平上的预防效果也得到了改善。例如，如果以40%的覆盖率引入OST，对于低（20%）、中（40%）或高（60%）基线ART覆盖率，ART在人群水平上的预防效果分别可提高27%、20%或13%。
结论
OST可提高ART的HIV预防效益；支持旨在同时扩大OST与ART规模的策略。
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