Antiretroviral Therapy and Pre-exposure Prophylaxis: Combined Impact on HIV Transmission and Drug Resistance in South Africa
Antiretroviral Therapy and Pre-exposure Prophylaxis: Combined Impact on HIV Transmission and Drug Resistance in South Africa
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DOI：
10.1093/infdis/jit150
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发表时间：
2013-07-15
影响因子：
6.4
通讯作者：
Mellors, John W.
中科院分区：
文献类型：
--
作者：
Abbas, Ume L.;Glaubius, Robert;Mellors, John W.
背景抗逆转录病毒治疗（ART）和暴露前预防（PrEP）与重叠和非重叠抗逆转录病毒（ARV）对人类免疫缺陷病毒（HIV）传播和耐药性的潜在影响尚不清楚。使用详细的数学模型来模拟南非单独使用ART、单独使用PrEP以及ART + PrEP联合使用的流行病学影响。结果。在CD 4淋巴细胞计数< 200个细胞/μ L（80%覆盖率和96%有效性）的情况下开始单独的抗逆转录病毒治疗，可在10年内预防20%的艾滋病毒感染，但使耐药性流行率增加到6.6%。单独的PrEP（30%的覆盖率和75%的有效性）也可以预防21%的感染，但耐药性流行率较低，为0.5%。10年后预防的累积感染与流行耐药病例的比率为PrEP比ART高7倍。ART + PrEP与重叠的ARV联合预防了35%的感染，但将耐药率提高至8. 2%;而ART + PrEP与非重叠的ARV联合预防了略多的感染（37%），并将耐药率降低至7. 2%。联合ART + PrEP可能比单独使用任何一种策略预防更多的艾滋病毒感染，但耐药性的发生率更高。预计ART比PrEP更容易产生耐药性。优化ART和PrEP的有效性和交付是预防艾滋病毒传播和耐药性的关键。
Background. The potential impact of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) with overlapping and nonoverlapping antiretrovirals (ARVs) on human immunodeficiency virus (HIV) transmission and drug resistance is unknown.Methods. A detailed mathematical model was used to simulate the epidemiological impact of ART alone, PrEP alone, and combined ART + PrEP in South Africa.Results. ART alone initiated at a CD4 lymphocyte cell count < 200 cells/mu L (80% coverage and 96% effectiveness) prevents 20% of HIV infections over 10 years but increases drug resistance prevalence to 6.6%. PrEP alone (30% coverage and 75% effectiveness) also prevents 21% of infections but with lower resistance prevalence of 0.5%. The ratio of cumulative infections prevented to prevalent drug-resistant cases after 10 years is 7-fold higher for PrEP than for ART. Combined ART + PrEP with overlapping ARVs prevents 35% of infections but increases resistance prevalence to 8.2%, whereas ART + PrEP with nonoverlapping ARVs prevents slightly more infections (37%) and reduces resistance prevalence to 7.2%.Conclusions. Combined ART + PrEP is likely to prevent more HIV infections than either strategy alone, but with higher prevalence of drug resistance. ART is predicted to contribute more to resistance than is PrEP. Optimizing both ART and PrEP effectiveness and delivery are the keys to preventing HIV transmission and drug resistance.