Brown Regina, Deeks Steven G, Eyal Nir
University of Massachusetts Medical School, Worcester, MA, USA.
University of California, San Francisco, School of Medicine, San Francisco, CA, USA.
J Virus Erad. 2018 Jul 1;4(3):182-185. doi: 10.1016/S2055-6640(20)30266-1.
Thinking about public health impact should inform HIV curative investigations. Should an effective HIV cure or sustained viral remission intervention emerge from ongoing investigations, implementation strategies aimed at ensuring global access will be needed if these approaches are to be impactful, and planning accordingly makes sense now. Specifically, we discuss three key access barriers to future cure-related interventions: high cost of the strategy; non-financial challenges to procurement, distribution and point-of-care delivery; and non-adherence and the need for long-term monitoring. As we argue, plans and decision-making for overcoming each of these barriers will need to be developed in advance. An evaluation of remaining barriers and likely global impact of the leading strategies under investigation should inform decisions on which strategy might receive funding priority. Among the strategies being investigated, implementation barriers for latency-reversing agents, immunotherapy and combination antiretroviral therapy (ART) may be overcome on a global scale with some effort. Overcoming implementation barriers for medically complex and high-risk interventions, such as stem cell and, to some degree, gene therapy, may be less feasible.
对公共卫生影响的考量应为艾滋病治愈研究提供指导。如果正在进行的研究能够产生有效的艾滋病治愈方法或实现病毒持续缓解的干预措施，那么要想这些方法产生影响，就需要制定旨在确保全球可及性的实施策略，因此现在进行相应规划是有意义的。具体而言，我们讨论未来与治愈相关干预措施的三个关键可及性障碍：策略成本高昂；采购、分发和现场治疗提供方面的非财务挑战；以及不依从性和长期监测的需求。正如我们所主张的，需要提前制定克服这些障碍的计划和决策。对正在研究的主要策略的剩余障碍和可能的全球影响进行评估，应能为确定哪些策略可能获得资金优先支持提供决策依据。在正在研究的策略中，通过一定努力，潜伏逆转剂、免疫疗法和联合抗逆转录病毒疗法（ART）的实施障碍在全球范围内或许可以克服。而克服医学上复杂且高风险的干预措施（如干细胞疗法以及在某种程度上的基因疗法）的实施障碍可能不太可行。
