Potential impact of antiretroviral chemoprophylaxis on HIV-1 transmission in resource-limited settings.
Potential impact of antiretroviral chemoprophylaxis on HIV-1 transmission in resource-limited settings.
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DOI：
10.1371/journal.pone.0000875
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发表时间：
2007-09-19
期刊：
影响因子：
3.7
通讯作者：
Mellors, John W.
中科院分区：
文献类型：
--
作者：
Abbas, Ume L.;Anderson, Roy M.;Mellors, John W.
在资源有限的环境中，暴露前化学预防（PrEP）对HIV-1感染异性传播的潜在影响尚不确定。采用确定性数学模型模拟抗逆转录病毒PrEP在不同情景下（乐观、中性和悲观）对撒哈拉以南非洲HIV-1流行的影响，包括有无性抑制解除。敏感性分析用于评估输入参数的不确定性对模型输出的影响，包括部分秩相关和标准化秩回归的计算。在开始PrEP后没有性解除抑制的情况下，影响预防感染的关键参数是PrEP的有效性（部分秩相关系数(PRCC) = 0.94）、PrEP停药率（PRCC = - 0.94）、覆盖率（PRCC = 0.92）和达到目标覆盖率的时间（PRCC = - 0.82）。在性解除抑制的情况下，PrEP的有效性和性解除抑制的程度对预防的影响最大。如果PrEP的有效性达到90%，一般人群覆盖率达到75%，那么在乐观的情况下，预计10年后HIV-1累计感染率将下降74%，针对高危人群（占总人口的16%）的PrEP将下降28.8%。即使性解除抑制导致的危险行为增加了100%，在广泛的覆盖范围内（25%-75%），90%的PrEP有效效果（感染减少23.4%-62.7%）也可以看到有益的效果。类似的去抑制导致PrEP有效性较低（≤50%）的感染增加。数学模型支持PrEP的潜在公共卫生效益。在撒哈拉以南非洲，通过针对行为风险最高的人群和预防性解除抑制，10年内可避免约270万至320万新的艾滋病毒-1感染。然而，这种益处可能会因性抑制解除和高剂量停用PrEP而丧失，特别是在PrEP有效性较低（≤50%）的情况下。
The potential impact of pre-exposure chemoprophylaxis (PrEP) on heterosexual transmission of HIV-1 infection in resource-limited settings is uncertain. A deterministic mathematical model was used to simulate the effects of antiretroviral PrEP on an HIV-1 epidemic in sub-Saharan Africa under different scenarios (optimistic, neutral and pessimistic) both with and without sexual disinhibition. Sensitivity analyses were used to evaluate the effect of uncertainty in input parameters on model output and included calculation of partial rank correlations and standardized rank regressions. In the scenario without sexual disinhibition after PrEP initiation, key parameters influencing infections prevented were effectiveness of PrEP (partial rank correlation coefficient (PRCC) = 0.94), PrEP discontinuation rate (PRCC = −0.94), level of coverage (PRCC = 0.92), and time to achieve target coverage (PRCC = −0.82). In the scenario with sexual disinhibition, PrEP effectiveness and the extent of sexual disinhibition had the greatest impact on prevention. An optimistic scenario of PrEP with 90% effectiveness and 75% coverage of the general population predicted a 74% decline in cumulative HIV-1 infections after 10 years, and a 28.8% decline with PrEP targeted to the highest risk groups (16% of the population). Even with a 100% increase in at-risk behavior from sexual disinhibition, a beneficial effect (23.4%–62.7% decrease in infections) was seen with 90% effective PrEP across a broad range of coverage (25%–75%). Similar disinhibition led to a rise in infections with lower effectiveness of PrEP (≤50%). Mathematical modeling supports the potential public health benefit of PrEP. Approximately 2.7 to 3.2 million new HIV-1 infections could be averted in southern sub-Saharan Africa over 10 years by targeting PrEP (having 90% effectiveness) to those at highest behavioral risk and by preventing sexual disinhibition. This benefit could be lost, however, by sexual disinhibition and by high PrEP discontinuation, especially with lower PrEP effectiveness (≤50%).
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影响因子：
168.9
作者：
Asamoah-Odei, E;Calleja, JMG;Boerma, JT
通讯作者：
Boerma, JT
影响因子：
56.9
作者：
COFFIN, JM
通讯作者：
COFFIN, JM
影响因子：
5.4
作者：
Charpentier, C;Dwyer, DE;Hance, AJ
通讯作者：
Hance, AJ
影响因子：
3.8
作者：
Brenner, Bluma G.;Oliveira, Maureen;Wainberg, Mark A.
通讯作者：
Wainberg, Mark A.
DOI：
10.1097/01.qai.0000194234.31078.bf
发表时间：
2006-04-15
影响因子：
3.6
作者：
Abbas, UL;Anderson, RM;Mellors, JW
通讯作者：
Mellors, JW