Stochastic simulation of the impact of antiretroviral therapy and HIV vaccines on HIV transmission; Rakai, Uganda
Stochastic simulation of the impact of antiretroviral therapy and HIV vaccines on HIV transmission; Rakai, Uganda
复制标题
DOI：
10.1097/00002030-200309050-00013
复制
发表时间：
2003-09-05
期刊：
影响因子：
3.8
通讯作者：
Quinn, TC
中科院分区：
文献类型：
--
作者：
Gray, RH;Li, XB;Quinn, TC
目的：为了模拟抗逆转录病毒疗法（ART）和艾滋病毒疫苗对艾滋病毒传播的影响，使用经验数据的研究在Rakai，Uganda.Design：一个随机模拟模型估计艾滋病毒的发病率，传播的概率，每次性交行为和生殖数（R-0）与ART和艾滋病毒疫苗。模型输入包括Rakai关于艾滋病毒载量、年龄和性别以及性行为的每次性交行为的艾滋病毒传播概率的数据。治疗的影响来自美国项目，疫苗假设包括25%至75%的预防效力。结果：模型的发病率[1.57/100人年（PY）]与经验数据（1.5/100 PY）非常接近。使用DHHS治疗指南模拟抗逆转录病毒疗法，预测艾滋病毒发病率下降，但R-0仍大于1.0，艾滋病毒阳性人数在20年内没有实质性变化。有效性> 50%和人口覆盖率> 50%的预防性疫苗可将R-0降至< 1.0，并在20年内大幅减少艾滋病毒感染者的数量。同时进行抗逆转录病毒疗法和预防性疫苗可以在较低的人口覆盖水平上产生重大影响，并将在20年内显著减少艾滋病毒感染人口。然而，无论是ART或疫苗接受者的性伴侣的数量增加，增加了艾滋病毒的发病率和减少干预impacts.Conclusion：ART单独不能控制艾滋病毒的流行在成熟的流行病，如Rakai，和需要治疗的人会随着时间的推移而增加的行为解除抑制。如果行为抑制解除被阻止，ART与低效力疫苗结合可以控制流行。(C)2003年利平科特威廉姆斯威尔金斯。
Objective: To model the effects of antiretroviral therapy (ART) and HIV vaccines on HIV transmission using empirical data from studies in Rakai, Uganda.Design: A stochastic simulation model estimated HIV incidence, probabilities of transmission per coital act and the reproductive number (R-0) with ART and HIV vaccines. Model inputs included Rakai data on HIV transmission probabilities per coital act by HIV viral load, age and gender, and sexual behaviors. The impacts of therapy were derived from US programs, and vaccine assumptions included preventive efficacies ranging from 25 to 75%. Component projection models estimated the numbers of HIV-infected persons over 20 years.Results: The model incidence [1.57/100 person years (PY)] closely fitted empirical data (1.5/100 PY). Simulations of ART using DHHS treatment guidelines, predicted declines in HIV incidence, but R-0 remained > 1.0, and the numbers of HIV-positive persons did not change substantially over 20 years. Preventive vaccines with > 50% efficacy and > 50% population coverage could reduce R-0 to < 1.0, and substantially reduce the number of HIV-infected persons over 20 years. Concurrent ART and a preventive vaccine can have substantial impact at lower levels of population coverage and would markedly reduce the HIV infected population over 20 years. However, behavioral disinhibition with increased numbers of sexual partners in either ART or vaccine recipients, increased HIV incidence and diminished intervention impact.Conclusion: ART alone cannot control the HIV epidemic in mature epidemics such as Rakai, and persons in need of therapy will increase over time. ART in combination with a low efficacy vaccine could control the epidemic, if behavioral disinhibition is prevented. (C) 2003 Lippincott Williams Wilkins.