Decreased HIV transmission after a policy of providing free access to highly active antiretroviral therapy in Taiwan
Decreased HIV transmission after a policy of providing free access to highly active antiretroviral therapy in Taiwan
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DOI：
10.1086/422601
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发表时间：
2004-09-01
影响因子：
6.4
通讯作者：
Chuang, CY
中科院分区：
文献类型：
--
作者：
Fang, CT;Hsu, HM;Chuang, CY
背景台湾于1989年建立了一个全国性的人体免疫机能丧失病毒（艾滋病毒）感染监测系统，并通过了一项政策，从1997年4月开始向所有感染艾滋病毒的公民免费提供高效抗逆转录病毒疗法。这提供了一个机会，以确定HAART的广泛使用对艾滋病病毒的演变的影响。我们分析了全国艾滋病毒监测数据。利用HIV流行的指数演化模型估计HIV传播率，并对监测数据进行拟合。截至2002年底，台湾感染艾滋病毒的公民累计人数已达4 390人（占总人口的0.019%）。在建立了免费获得高效抗逆转录病毒治疗后，估计的艾滋病毒传播率下降了53%（0.391对0.184例新病例/流行病例年[95%置信区间，31%-65%]）。在同一时期，在一般人群或HIV阳性患者中，梅毒的发病率没有统计学显著变化。为所有HIV感染者提供免费的HAART治疗，使HIV传播率降低了53%，有助于台湾HIV流行的控制。
Background. Taiwan established a nationwide surveillance system for human immunodeficiency virus (HIV) infection in 1989 and adopted a policy to provide all HIV-infected citizens with free access to highly active antiretroviral therapy ( HAART) beginning in April 1997. This provided an opportunity to determine the effect of the widespread use of HAART on the evolution of the HIV epidemic.Methods. We analyzed national HIV surveillance data. The HIV transmission rate was estimated by use of an exponential model of HIV epidemic evolution, with statistical projection over the interval between infection and detection to fit the surveillance data.Results. By the end of 2002, the cumulative number of HIV-infected citizens in Taiwan had reached 4390 (0.019% of the total population). After free access to HAART was established, the estimated HIV transmission rate decreased by 53% (0.391 vs. 0.184 new cases/prevalent case-year [95% confidence interval, 31%-65%]). There was no statistically significant change in the incidence of syphilis, in the general population or among HIV-positive patients, during the same period.Conclusion. Providing free HAART to all HIV-infected citizens was associated with a 53% decrease in the HIV transmission rate and contributed to the control of the HIV epidemic in Taiwan.