Challenges in optimizing preexposure prophylaxis development, engagement, and access for HIV prevention.
Challenges in optimizing preexposure prophylaxis development, engagement, and access for HIV prevention.
复制标题
优化艾滋病毒预防的暴露前预防开发、参与和获取方面的挑战。
DOI：
10.1172/jci134389
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Blankson,JoelN
中科院分区：
文献类型：
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作者：
Scully,EileenP;Weld,EthelD;Blankson,JoelN
现代科学的最大成就之一是发展了有效的抗逆转录病毒疗法（ART）来控制HIV-1感染。可以说，对正在进行的艾滋病毒流行病的更具创新性的反应之一是将ART重新用于预防工作，作为暴露前预防（PrEP）。面对2018年约170万新感染病例以及缺乏有效的艾滋病毒疫苗，这一战略至关重要。尽管取得了这一进展，但PrEP的最佳实施仍然存在重大的科学挑战，仍然需要新的方法（1）。在美国，目前批准的PrEP由一粒药丸组成，每天服用两种抗逆转录病毒药物。虽然这种治疗方案大大降低了HIV-1感染的风险，但即使在资源丰富的环境中，PrEP仍然没有达到大多数高危人群（2）。全面的预防服务是卫生与公众服务部结束艾滋病毒流行战略计划的基石（3），PrEP是目前可用的生物医学干预措施。预防性干预措施处于医学和行为科学的交叉点，其推出可以突出卫生保健获取方面的差距。PrEP也不例外，需要做出严格的努力，才能在不同群体中公平地发挥其潜力。我们建议PrEP为结束艾滋病毒流行的努力提供了一个窗口，同时也阐明了生物医学科学创新与其在公共卫生工作中的应用之间的紧张关系。
One of the greatest successes of modern science is the development of effective antiretroviral therapy (ART) for control of HIV-1 infection. Arguably one of the more innovative responses to the ongoing HIV epidemic is the repurposing of ART for preventive efforts as preexposure prophylaxis (PrEP). This strategy has been critical in the face of approximately 1.7 million new infections in 2018 and in the absence of an effective HIV vaccine. Notwithstanding this advance, significant scientific challenges remain for the optimal implementation of PrEP, and novel approaches are still needed (1).In the United States, currently approved PrEP consists of a single pill containing two antiretroviral drugs taken daily. While this regimen substantially reduces the risk of HIV-1 acquisition, PrEP has still not reached the majority of at-risk individuals, even in resource-rich settings (2). Comprehensive preventive services are a cornerstone of the Department of Health and Human Services’ strategic plan to end the HIV epidemic (3), and PrEP is the biomedical intervention currently available. Preventive interventions are at the intersection of medical and behavioral science, and their rollout can highlight disparities in health care access. PrEP is no different, requiring rigorous efforts to achieve its potential equitably across diverse groups. We propose that PrEP offers a window into the efforts to end the HIV epidemic while also illuminating the tension between innovation in biomedical science and its application in public health efforts.