NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
Key Laboratory of AIDS Immunology of Liaoning Province, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
BMC Infect Dis. 2019 Jul 25;19(1):663. doi: 10.1186/s12879-019-4275-x.
Biomedical interventions such as antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are highly effective for prevention of human immunodeficiency virus (HIV) infection. However, China has not released national PrEP guidelines, and HIV incidence among men who have sex with men (MSM) is unchanged despite substantial scale-up of ART. We evaluated reductions in HIV transmission that may be achieved through early initiation of ART plus partners' PrEP.
Six intervention scenarios were evaluated in terms of their impact on HIV transmission and their cost-effectiveness for 36 months post-infection. Three scenarios were based on observed data: non-ART, standard-ART, and early-ART. Another three scenarios were based on observed and hypothetical data: non-ART plus partners' PrEP, standard-ART plus partners' PrEP, and early-ART plus partners' PrEP. The number of onward transmissions was calculated according to viral load and self-reported sexual behaviors, and calibrated by the prevalence and incidence of HIV among Chinese MSM. Cost-effectiveness outcomes were quality-adjusted life-years (QALYs) and cost-utility ratio (CUR).
The estimated number of onward transmissions by every 100 HIV-positive cases 36 months post-infection was 41.83 (95% credible interval: 30.75-57.69) in the non-ART scenario, 7.95 (5.85-10.95) in the early-ART scenario, and 0.79 (0.58-1.09) in the early-ART plus partners' PrEP scenario. Compared with non-ART, the early-ART and early-ART plus partners' PrEP scenarios were associated with an 81.0 and 98.1% reduction in HIV transmission, and had a CUR of $12,864/QALY and $16,817/QALY, respectively.
Integrated delivery of early ART and sexual partners' PrEP could nearly eliminate HIV transmission and reduce costs during the first 36 months of HIV infection. Our results suggest a feasible and cost-effective strategy for reversing the HIV epidemic among MSM in China.
抗逆转录病毒疗法（ART）和暴露前预防（PrEP）等生物医学干预措施对预防人类免疫缺陷病毒（HIV）感染非常有效。然而，中国尚未发布国家 PrEP 指南，尽管 ART 大规模推广，但男男性行为者（MSM）中的 HIV 发病率并未改变。我们评估了通过早期启动 ART 加性伴侣 PrEP 可能实现的 HIV 传播减少。
评估了六个干预场景对 HIV 传播的影响及其在感染后 36 个月的成本效益。三个场景基于观察数据：非 ART、标准 ART 和早期 ART。另外三个场景基于观察数据和假设数据：非 ART 加性伴侣 PrEP、标准 ART 加性伴侣 PrEP 和早期 ART 加性伴侣 PrEP。根据病毒载量和自我报告的性行为计算了继发传播的数量，并根据中国 MSM 中 HIV 的流行率和发病率进行了校准。成本效益结果是质量调整生命年（QALY）和成本效用比（CUR）。
感染后 36 个月每 100 例 HIV 阳性病例估计的继发传播数量在非 ART 方案中为 41.83（95%可信区间：30.75-57.69），在早期 ART 方案中为 7.95（5.85-10.95），在早期 ART 加性伴侣 PrEP 方案中为 0.79（0.58-1.09）。与非 ART 相比，早期 ART 和早期 ART 加性伴侣 PrEP 方案与 HIV 传播减少 81.0%和 98.1%相关，成本效用比分别为 12864 美元/QALY 和 16817 美元/QALY。
早期 ART 和性伴侣 PrEP 的综合提供几乎可以消除 HIV 传播，并在 HIV 感染的头 36 个月内降低成本。我们的结果表明，在中国扭转 MSM 中的 HIV 流行是可行且具有成本效益的策略。
