Department of Biostatistics, School of Public Health, Brown University, Providence, Rhode Island, USA.
Department of Epidemiology, and School of Public Health, Brown University, Providence, Rhode Island, USA.
AIDS Patient Care STDS. 2020 Dec;34(12):506-515. doi: 10.1089/apc.2020.0151. Epub 2020 Nov 19.
Although there is ongoing debate over the need for substantial increases in pre-exposure prophylaxis (PrEP) use when antiretroviral treatment confers the dual benefits of reducing HIV-related morbidity and mortality and the risk of HIV transmission, no studies to date have quantified the potential added benefits of PrEP use and changes in its efficiency in the context of high treatment engagement across multiple US subpopulations. We used a previously published agent-based model to simulate HIV transmission in a dynamic network of Black/African American and White men who have sex with men (MSM) in Atlanta, Georgia (2015-2024) to understand how reductions in HIV incidence attributable to varying levels of PrEP use change when United Nations Joint Programme on HIV/AIDS (UNAIDS) "90-90-90" goals for HIV treatment are achieved and maintained. Even at achievement of "90-90-90" goals, 75% PrEP coverage further reduced incidence by 67.9% and 74.2% to 1.53 [simulation interval (SI): 1.39-1.70] and 0.355 (SI: 0.316-0.391) per 100 person-years for Black/African American and White MSM, respectively, compared with the same scenario with no PrEP use. Increasing PrEP coverage from 15% to 75% under "90-90-90" goals only increased the number of person-years of PrEP use per infection averted by 8.1% and 10.5% to 26.7 (SI: 25.6-28.0) and 73.3 (SI: 70.6-75.7) among Black/African American MSM and White MSM, respectively. Even with high treatment engagement, substantial expansion of PrEP use contributes to meaningful decreases in HIV incidence among MSM with minimal changes in efficiency.
虽然在抗逆转录病毒治疗既降低与 HIV 相关的发病率和死亡率，又降低 HIV 传播风险的双重获益背景下，对于是否需要大幅增加暴露前预防（PrEP）的使用，目前仍存在争议，但迄今为止，尚无研究在多个美国亚人群中量化 PrEP 使用的潜在额外获益以及在高治疗参与度情况下 PrEP 效率的变化。我们使用之前发表的基于代理的模型，模拟了佐治亚州亚特兰大市的黑人和白人男男性行为者（MSM）的动态网络中的 HIV 传播，以了解在实现和维持联合国艾滋病规划署（UNAIDS）“90-90-90”艾滋病毒治疗目标的情况下，因 PrEP 使用水平的不同而降低的 HIV 发病率变化情况。即使实现了“90-90-90”目标，75%的 PrEP 覆盖率仍将发病率降低了 67.9%和 74.2%，分别降至每 100 人年 1.53 例（SI：1.39-1.70）和 0.355 例（SI：0.316-0.391），而在无 PrEP 使用的情况下，黑人和白人 MSM 的发病率分别为每 100 人年 2.41 例（SI：2.24-2.59）和 0.759 例（SI：0.704-0.815）。在“90-90-90”目标下，将 PrEP 覆盖率从 15%提高到 75%，仅将每例感染预防的 PrEP 使用人年数增加了 8.1%和 10.5%，分别为 26.7 人年（SI：25.6-28.0）和 73.3 人年（SI：70.6-75.7），黑人和白人 MSM 分别增加了 26.7 人年（SI：25.6-28.0）和 73.3 人年（SI：70.6-75.7）。即使治疗参与度很高，PrEP 的广泛使用也会大大降低 MSM 的 HIV 发病率，而效率的变化微乎其微。
