Minimizing fungal disease deaths will allow the UNAIDS target of reducing annual AIDS deaths below 500 000 by 2020 to be realized
Minimizing fungal disease deaths will allow the UNAIDS target of reducing annual AIDS deaths below 500 000 by 2020 to be realized
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DOI：
10.1098/rstb.2015.0468
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发表时间：
2016-12-05
影响因子：
6.3
通讯作者：
Denning，David W.
中科院分区：
文献类型：
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作者：
Denning，David W.
艾滋病死亡人数（2013年为1 500 000人）的下降速度慢于预期，因为获得抗逆转录病毒疗法的机会有所改善。艾滋病相关的死亡大多数是由寄生虫感染引起的，死亡的中位年龄在35岁左右。大约36万（24%）艾滋病死亡是由于结核病。艾滋病真菌感染死亡人数估计每年超过70万人（47%）。快速诊断工具和抗真菌剂可用于这些疾病，并可能对减少死亡产生重大影响。减少可避免死亡的情景是根据到2020年诊断和非专利抗真菌药物对现实生活影响的已发表结果构建的。隐球菌病、肺孢子虫病、播散性组织胞浆菌病和慢性肺曲霉病的年死亡人数分别减少70，000、162，500、48，000和33，500，诊断和抗真菌药物的覆盖率约为60%; 5年内共挽救了1，000，000人的生命。如果考虑到90-90-90运动的推出及其效果，到2020年，艾滋病死亡人数可能会下降到每年42.6万人，随着覆盖率的增加，可能会进一步减少。捐助者、国家和国际公共卫生机构、非政府组织和各国政府可以也应该采取行动，通过提高检测和治疗艾滋病真菌病的能力，实现联合国艾滋病规划署降低死亡率的目标。
Deaths from AIDS (1 500 000 in 2013) have been falling more slowly than anticipated with improved access to antiretroviral therapy. Opportunistic infections account for most AIDS-related mortality, with a median age of death in the mid-30s. About 360 000 (24%) of AIDS deaths are attributed to tuberculosis. Fungal infections deaths in AIDS were estimated at more than 700 000 deaths (47%) annually. Rapid diagnostic tools and antifungal agents are available for these diseases and would likely have a major impact in reducing deaths. Scenarios for reduction of avoidable deaths were constructed based on published outcomes of the real-life impact of diagnostics and generic antifungal drugs to 2020. Annual deaths could fall for cryptococcal disease by 70 000,Pneumocystispneumonia by 162 500, disseminated histoplasmosis by 48 000 and chronic pulmonary aspergillosis by 33 500, with approximately 60% coverage of diagnostics and antifungal agents; a total of >1 000 000 lives saved over 5 years. If factored in with the 90–90–90 campaign rollout and its effect, AIDS deaths could fall to 426 000 annually by 2020, with further reductions possible with increased coverage. Action could and should be taken by donors, national and international public health agencies, NGOs and governments to achieve the UNAIDS mortality reduction target, by scaling up capability to detect and treat fungal disease in AIDS.This article is part of the themed issue ‘Tackling emerging fungal threats to animal health, food security and ecosystem resilience’.