Potential impact of antiretroviral therapy on HIV-1 transmission and AIDS mortality in resource-limited settings
Potential impact of antiretroviral therapy on HIV-1 transmission and AIDS mortality in resource-limited settings
复制标题
DOI：
10.1097/01.qai.0000194234.31078.bf
复制
发表时间：
2006-04-15
影响因子：
3.6
通讯作者：
Mellors, JW
中科院分区：
文献类型：
--
作者：
Abbas, UL;Anderson, RM;Mellors, JW
目的：评估资源有限环境中抗逆转录病毒治疗对 HIV-1 感染异性传播和艾滋病死亡率的潜在影响。方法：使用 HIV-1 疾病进展和传播的数学模型来评估不同抗逆转录病毒治疗方案（包括世界卫生组织指南的实施）下的表皮学结果。结果：在 5% HIV-1 流行率下实施抗逆转录病毒治疗，并对 100% 的艾滋病病例进行治疗，预计可减少新发 HIV-1 病例10 年后艾滋病感染率和累计死亡人数分别减少 11.2%（四分位数范围 [IQR]：1.8%-21.4%）和 33.4%（IQR：26%-42.8%）。预计稍后在地方病平衡（40％患病率）下实施治疗的效果会较差，新发 HIV-1 感染和艾滋病累计死亡人数分别减少 10.5％（IQR：2.6％-19.3％）和 27.6％（IQR：20.8％-36.8％）。预计治疗将通过减少传播和艾滋病死亡而使受感染的个人和未受感染的社区受益。治疗25年后，社区效益大于个人效益，并随着治疗的艾滋病病例比例的增加而增加。结论：预计抗逆转录病毒治疗对个人和公共健康的效益会随着时间和治疗的感染者比例的增加而增加。在流行病早期引入治疗的效果更大，但治疗中的残留感染或疾病进展以及一般人群的性抑制解除可能会导致治疗效果丧失。
Objective: To estimate the potential impact of antiretroviral therapy on the heterosexual spread of HIV-1 infection and AIDS mortality in resource limited settings.Methods: A mathematic model of HIV-1 disease progression and transmission was used to assess epidermologic outcomes under different scenarios of antiretroviral therapy, including implementation of World Health Organization guidelines.Results: Implementing antiretroviral therapy at 5% HIV-1 prevalence and administering it to 100% of AIDS cases are predicted to decrease new HIV-1 infections and cumulative deaths from AIDS after 10 years by 11.2% (inter-quartile range [IQR]: 1.8%-21.4%) and 33.4% (IQR: 26%-42.8%), respectively. Later implementation of therapy at endemic equilibrium (40% prevalence) is predicted to be less effective, decreasing new HIV-1 infections and cumulative deaths from AIDS by 10.5% (IQR: 2.6%-19.3%) and 27.6% (IQR: 20.8%-36.8%), respectively. Therapy is predicted to benefit the infected individual and the uninfected Community by decreasing transmission and AIDS deaths. The community benefit is greater than the individual benefit after 25 years of treatment and increases with the proportion of AIDS cases treated.Conclusions: Antiretroviral therapy is predicted to have individual and public health benefits that increase with time and the proportion of infected persons treated. The impact of therapy is greater when introduced earlier in an epidemic, but the benefit can be lost by residual infectivity or disease progression on treatment and by sexual disinhibition of the general population.