Who will Benefit from a Wide-Scale Introduction of Vaginal Microbicides in Developing Countries?
Who will Benefit from a Wide-Scale Introduction of Vaginal Microbicides in Developing Countries?
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DOI：
10.2202/1948-4690.1012
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发表时间：
2010-01
期刊：
影响因子：
--
通讯作者：
Boily MC
中科院分区：
文献类型：
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作者：
Dimitrov DT;Masse B;Boily MC
阴道杀微生物剂是目前为数不多的旨在帮助妇女降低感染艾滋病毒风险的生物医学干预措施之一。然而，含有抗逆转录病毒的杀微生物剂（ARV-VMB）可能导致抗逆转录病毒耐药性的发展，并可能在人口一级对男性更有利。我们开发了一个数学模型来研究大规模人群使用VMB对异性恋人群的影响。在63种不同的干预方案中，包括艾滋病毒阳性妇女连续和中断使用抗逆转录病毒-万古霉素，对预防感染和降低流行率的性别比例进行了评价。还利用从代表发展中国家的主要范围中抽样的参数，通过蒙特卡罗模拟研究了不同因素对人口一级福利的影响。我们的分析表明，女性比男性更有可能从ARV-VMB的使用中受益，因为在研究的63，000个模拟中（在不同的参数集下）有78-80%显示女性优势，无论是以预防的累积感染数量，预防的累积感染百分比还是预期的患病率降低来衡量。按设想方案进行的分层分析表明，在各种设想方案中，男性在预防感染方面的优势可能性从6%到49%不等。只有当全身吸收和对ARV-VMB产生耐药性的风险很高，并且艾滋病毒阳性妇女无限期地不间断地使用VMB时，才是实质性的。因此，使用抗逆转录病毒/万古霉素，加上成功的控制措施限制艾滋病毒抗体阳性妇女的使用，仍然是一种非常适合女性的预防工具。
Vaginal microbicides (VMB) are currently among the few biomedical interventions designed to help women reduce their risk of acquiring HIV infection. However, the microbicide containing antiretroviral (ARV-VMB) may lead to the development of antiretroviral resistance and could paradoxically become more beneficial to men at the population level. We developed a mathematical model to study the impact of a wide-scale population usage of VMB in a heterosexual population. Gender ratios of prevented infections and prevalence reduction are evaluated in 63 different intervention schedules including continuous and interrupted ARV-VMB use by HIV-positive women. The influence of different factors on population-level benefits is also studied through Monte Carlo simulations using parameters sampled from primary ranges representative of developing countries. Our analysis indicates that women are more likely than men to benefit from ARV-VMB use since 78-80% of the total 63,000 simulations investigated (under different parameter sets) showed a female advantage whether benefit is measured as cumulative number of infections prevented, the percentage of cumulative infections prevented, or the expected reduction in prevalence. Stratified analysis by scenarios indicates that the likelihood of a male advantage with respect to the fractions of prevented infections varies from 6% to 49% among the scenarios. It is substantial only if the risk of systemic absorption and development of resistance to ARV-VMB is high and the HIV-positive women use VMB indefinitely without interruption. Therefore, the use of ARV-VMB, with successful control measures restricting usage by HIV-positive women, is still very much a female prevention tool.