The Desmond Tutu HIV Centre, University of Cape Town, RSA, Cape Town, South Africa.
Duke Global Health Institute, Duke University, Durham, NC, USA.
Nat Rev Dis Primers. 2023 Aug 17;9(1):42. doi: 10.1038/s41572-023-00452-3.
The AIDS epidemic has been a global public health issue for more than 40 years and has resulted in ~40 million deaths. AIDS is caused by the retrovirus, HIV-1, which is transmitted via body fluids and secretions. After infection, the virus invades host cells by attaching to CD4 receptors and thereafter one of two major chemokine coreceptors, CCR5 or CXCR4, destroying the host cell, most often a T lymphocyte, as it replicates. If unchecked this can lead to an immune-deficient state and demise over a period of ~2-10 years. The discovery and global roll-out of rapid diagnostics and effective antiretroviral therapy led to a large reduction in mortality and morbidity and to an expanding group of individuals requiring lifelong viral suppressive therapy. Viral suppression eliminates sexual transmission of the virus and greatly improves health outcomes. HIV infection, although still stigmatized, is now a chronic and manageable condition. Ultimate epidemic control will require prevention and treatment to be made available, affordable and accessible for all. Furthermore, the focus should be heavily oriented towards long-term well-being, care for multimorbidity and good quality of life. Intense research efforts continue for therapeutic and/or preventive vaccines, novel immunotherapies and a cure.
艾滋病疫情已持续 40 多年,是全球公共卫生的重大挑战,造成约 4000 万人死亡。艾滋病由逆转录病毒 HIV-1 引起,可通过体液和分泌物传播。病毒感染后,通过与 CD4 受体结合,继而与两种主要趋化因子核心受体之一 CCR5 或 CXCR4 结合,侵入宿主细胞,在复制过程中破坏宿主细胞,通常是 T 淋巴细胞。如果不加以控制,这可能导致免疫功能缺陷,在 2-10 年内死亡。快速诊断和有效的抗逆转录病毒疗法的发现和全球推广,大大降低了死亡率和发病率,使越来越多的人需要终身接受病毒抑制治疗。病毒抑制可以消除病毒的性传播,并极大地改善健康结果。虽然艾滋病仍然受到污名化,但现在它是一种可以长期控制的慢性病。要想实现艾滋病疫情的最终控制,需要普及、负担得起和可及的预防和治疗措施。此外,应该把重点放在长期的健康、多种疾病的护理和良好的生活质量上。目前,正在进行大量的研究,以寻找治疗性和/或预防性疫苗、新型免疫疗法和治愈方法。