de Mendoza Carmen
Puerta de Hierro Research Institute, Majadahonda, Spain.
AIDS Rev. 2017 Oct-Dec;19(4):239.
The latest estimate from the WHO is of nearly 37 million people living with HIV worldwide by the end of 2016. Roughly 20 million are receiving antiretroviral therapy. Despite this progress in diagnosis and treatment, nearly 2 million new HIV infections continue to occur annually. Whereas men having sex with men (MSM) represent the major risk population for incident cases in North America and the European Union, infection of heterosexual women is the major group in Sub-Saharan Africa. Injection drug use is a leading mechanism of HIV acquisition in Asia, including Russia and the former Soviet republics. Given that HIV cannot be eradicated from infected persons, antiretroviral therapy prescribed as early as possible and forever has become the paradigm to both avoid clinical progression and prevent further transmissions. No protective vaccines are on the horizon, at least within a 5-year view. New genetic strategies (i.e., using CRISPR) that pursue elimination or lethal dysfunction of the HIV provirus hidden in human cell reservoirs have renewed the interest for HIV cure. Ultimately, they represent the most serious hope for controlling and eliminating the HIV pandemics. In the mean time, the benefit of antiretrovirals is being extended using oral drugs at demand in uninfected persons at risk as pre-exposure prophylaxis (PrEP). However, accompanying declines in condom use and increases in sexually transmitted infections are a major concern promoting PrEP. Alerts on rising syphilis and gonorrhea, and outbreaks of acute hepatitis C and now hepatitis A reflect the lack of adequate education, especially among MSM. Altogether, the updated figures from WHO and UNAIDS on the current status of the HIV epidemics suggest that a plateau may have been reached. Thereby, major efforts will be further required to envision a HIV/AIDS-free world. Major gaps still exist in access to antiretroviral therapy, diagnosis of people unaware of their infection, education on risk behaviors and interventions for preventing new HIV infections.
世界卫生组织的最新估计显示，截至2016年底，全球有近3700万人感染艾滋病毒。约2000万人正在接受抗逆转录病毒治疗。尽管在诊断和治疗方面取得了这一进展，但每年仍有近200万新的艾滋病毒感染病例出现。在北美和欧盟，男男性行为者是新增病例的主要风险人群，而在撒哈拉以南非洲，异性恋女性感染是主要群体。注射吸毒是亚洲（包括俄罗斯和前苏联各共和国）艾滋病毒感染的主要途径。鉴于无法从感染者体内根除艾滋病毒，尽早并终身开具抗逆转录病毒治疗药物已成为避免临床进展和防止进一步传播的范例。至少在未来5年内，尚无可用的保护性疫苗。旨在消除或使隐藏在人体细胞储存库中的艾滋病毒前病毒产生致命功能障碍的新基因策略（如使用CRISPR技术），重新燃起了人们对治愈艾滋病毒的兴趣。最终，它们是控制和消除艾滋病毒大流行的最重大希望。与此同时，抗逆转录病毒药物的益处正通过按需向有感染风险的未感染者提供口服药物作为暴露前预防（PrEP）得以扩展。然而，随之而来的避孕套使用减少和性传播感染增加是推动PrEP面临的一个主要问题。梅毒和淋病病例上升以及急性丙型肝炎乃至甲型肝炎疫情的警报，反映出缺乏充分的教育，尤其是在男男性行为者中。总之，世界卫生组织和联合国艾滋病规划署关于艾滋病毒疫情现状的最新数据表明，可能已达到一个平稳期。因此，要设想一个无艾滋病毒/艾滋病的世界，仍需付出更大努力。在获得抗逆转录病毒治疗、诊断未意识到自身感染的人群、开展风险行为教育以及预防新的艾滋病毒感染的干预措施等方面，仍然存在重大差距。
