Günthard Huldrych F, Kusejko Katharina, Kouyos Roger D
Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
Nat Rev Microbiol. 2025 Jun 30. doi: 10.1038/s41579-025-01202-w.
Despite decades of research and medical advances, the HIV-1 pandemic still presents major public health challenges, with most countries failing to meet the defined targets for HIV elimination. HIV-1 is the first chronic viral disease for which extensive virus sequence data became available through genotypic resistance testing. Phylogenetic methods have been instrumental in answering pathogenesis-related questions, such as ongoing viral replication on antiretroviral therapy and the role of the viral genome in pathogenesis and immunity. Molecular data have also largely enabled the development and application of phylogenetic and molecular epidemiology approaches to large populations, providing unique insights. These insights include the origin and timing of the HIV-1 pandemic, its global spread, transmission dynamics within and between subpopulations, and quantifying the impact of public health interventions on ongoing transmission. Such knowledge is essential for improving our understanding of key epidemic dynamics at both the micro and macro levels, as well as of the underlying biological mechanisms. In the future, these insights could be provided in real time to guide and optimize prevention measures. Molecular public health approaches should be expanded, particularly in low-income and middle-income countries where most of the pandemic's burden persists.
尽管经过数十年的研究和医学进步，HIV-1大流行仍然带来重大的公共卫生挑战，大多数国家未能实现消除HIV的既定目标。HIV-1是第一种通过基因型耐药性检测可获得大量病毒序列数据的慢性病毒性疾病。系统发育方法在回答与发病机制相关的问题方面发挥了重要作用，例如抗逆转录病毒治疗期间病毒的持续复制以及病毒基因组在发病机制和免疫中的作用。分子数据在很大程度上还推动了系统发育和分子流行病学方法在大量人群中的开发和应用，提供了独特的见解。这些见解包括HIV-1大流行的起源和时间、其全球传播、亚人群内部和之间的传播动态，以及量化公共卫生干预措施对持续传播的影响。此类知识对于增进我们在微观和宏观层面上对关键流行动态以及潜在生物学机制的理解至关重要。未来，这些见解可以实时提供，以指导和优化预防措施。分子公共卫生方法应予以扩展，尤其是在大多数大流行负担仍然存在的低收入和中等收入国家。
