UNC Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27516, USA.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, 02115, USA.
BMC Public Health. 2018 Feb 13;18(1):245. doi: 10.1186/s12889-018-5141-2.
The landscape of Human Immunodeficiency Virus (HIV) research has changed drastically over the past three decades. With the remarkable success of antiretroviral treatment (ART) in decreasing AIDS-related mortality, some researchers have shifted their HIV research focus from treatment to cure research. The HIV cure research community often uses the term eradication to describe the science, and talks about eradicating the virus from the body. In public discourse, the term eradication could be conflated with disease eradication at the population level. In this paper, we call for a reframing of HIV cure research as control, as it is a more accurate descriptor and achievable goal in the foreseeable future.
The properties of HIV are discordant with eradicability standards at both the individual level (as a clinical concept), and at the population level (as a public health concept). At the individual level, true eradication would necessitate absolute elimination of all latent HIV reservoirs from the body. Current HIV cure-related research strategies have proven unsuccessful at accurately quantifying, let alone eliminating these reservoirs. At the population level, eradication implies the permanent global reduction of HIV to zero new cases and to zero risk for future cases. Given the absence of an efficacious HIV vaccine and the impracticality and unethicality of eliminating animal reservoirs, global eradication of HIV is highly implausible. From a public health perspective, HIV eradication remains an elusive goal.
The term 'eradication' is a misleading description of current HIV cure-related research. Instead, we call for the use of more realistic expressions such as 'sustained virologic HIV suppression (or control)' or 'management of HIV persistence' to describe HIV cure-related research. Using these terms reorients what HIV cure science can potentially achieve in the near future and avoids creating unrealistic expectations, particularly among the millions of people globally who live with HIV.
在过去的三十年中，人类免疫缺陷病毒 (HIV) 研究的格局发生了巨大变化。随着抗逆转录病毒治疗 (ART) 在降低艾滋病相关死亡率方面取得显著成功，一些研究人员已将 HIV 研究重点从治疗转移到治愈研究。HIV 治愈研究界经常使用“根除”一词来描述科学，并谈论从体内根除病毒。在公共话语中，“根除”一词可能与人群层面的疾病根除相混淆。在本文中，我们呼吁将 HIV 治愈研究重新定义为“控制”，因为这是一个在可预见的未来更准确的描述和可实现的目标。
HIV 的特性与个体层面（作为临床概念）和人群层面（作为公共卫生概念）的根除标准不一致。在个体层面上，真正的根除需要从体内绝对消除所有潜伏的 HIV 储库。目前与 HIV 治愈相关的研究策略在准确量化这些储库方面已被证明是不成功的，更不用说消除这些储库了。在人群层面上，根除意味着永久性地将全球 HIV 减少到零新病例，以及未来病例的零风险。鉴于缺乏有效的 HIV 疫苗以及消除动物储库的不切实际和不道德性，全球根除 HIV 的可能性极低。从公共卫生的角度来看，HIV 根除仍然是一个难以实现的目标。
“根除”一词是对当前 HIV 治愈相关研究的误导性描述。相反，我们呼吁使用更现实的表述，如“持续的病毒学 HIV 抑制（或控制）”或“HIV 持续感染的管理”来描述 HIV 治愈相关研究。使用这些术语重新定位了 HIV 治愈科学在不久的将来可能实现的目标，并避免了在全球数百万艾滋病毒感染者中产生不切实际的期望。
