The future role of rectal and vaginal microbicides to prevent HIV infection in heterosexual populations: implications for product development and prevention.
The future role of rectal and vaginal microbicides to prevent HIV infection in heterosexual populations: implications for product development and prevention.
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DOI：
10.1136/sextrans-2011-050184
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发表时间：
2011-12
影响因子：
3.6
通讯作者：
Mâsse B
中科院分区：
文献类型：
--
作者：
Boily MC;Dimitrov D;Abdool Karim SS;Mâsse B
比较直肠（RMB）、阴道（VMB）和双室（RVMB）（阴道使用，在阴道和肛门性交期间保护）杀微生物剂预防不同异性恋人群中HIV的潜在影响。了解对于进行肛交（AI）的女性，RMB何时与VMB一样有用。使用数学模型评估3种不同杀微生物剂在各种干预方案和流行情况下的人群水平影响（预防的新发艾滋病毒感染累积分数（CFP））。我们得出了与VMB相比，降低女性HIV感染累积风险所需的盈亏平衡RMB功效。在乐观的覆盖率下（快速推广，100%吸收），在无AI的人群中75%的性行为中使用50%有效的VMB可以在25年内预防约33%[27，42%]的新的总（男性和女性合并）HIV感染。如果摄取量降至75%和50%，25年CFP分别降至约25%[20，32%]和17% [13，23%]。如果在AI为5-10%和RRRAI=4-20的人群中引入相同的VMB，则观察到类似的影响损失（25-50%）。如果RRRAI=20，则RMB与VMB（即盈亏平衡）在AI为5%的人群中一样有用，如果RRRAI=4，则在AI为15-20%的人群中一样有用，只要两种产品的依从性相同，则与依从性无关。当AI=10%和RRRAI=10时，RVMB的10年CFP比VMB或RMB大2倍。即使AI频率较低，也会影响VMB干预的效果。RMB和RVMB将成为异性恋人群的重要预防工具。
To compare the potential impact of rectal(RMB), vaginal(VMB) and bi-compartment(RVMB) (applied vaginally and protective during vaginal and anal intercourse) microbicides to prevent HIV in various heterosexual populations. To understand when a RMB is as useful than a VMB for females practicing anal intercourse(AI). Mathematical model was used to assess the population-level impact (cumulative fraction of new HIV infections prevented(CFP)) of the 3 different microbicides in various intervention scenarios and prevalence settings. We derived the break-even RMB efficacy required to reduce a female’s cumulative risk of HIV infection by the same amount than a VMB. Under optimistic coverage (fast roll-out, 100% uptake), a 50% efficacious VMB used in 75% of sex acts in population without AI may prevent ~33%[27,42%] new total (males and females combined) HIV infections over 25 years. The 25-year CFP reduces to ~25%[20,32%] and 17% [13,23%] if uptake decreases to 75% and 50%, respectively. Similar loss of impact (by 25–50%) is observed if the same VMB is introduced in populations with 5–10% AI and for RRRAI=4–20. A RMB is as useful as a VMB (i.e. break-even) in populations with 5% AI if RRRAI=20, and in populations with 15–20% AI if RRRAI=4, independently of adherence as long as it is the same with both products. The 10-year CFP with a RVMB is 2-fold larger than for a VMB or RMB when AI=10% and RRRAI=10. Even low AI frequency can compromise the impact of VMB interventions. RMB and RVMB will be important prevention tools for heterosexual populations.
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影响因子：
56.3
作者：
Boily, Marie-Claude;Baggaley, Rebecca F.;Wang, Lei;Masse, Benoit;White, Richard G.;Hayes, Richard J.;Alary, Michel
通讯作者：
Alary, Michel
影响因子：
3.6
作者：
Boily MC;Desai K;Masse B;Gumel A
通讯作者：
Gumel A
影响因子：
4.9
作者：
Halperin, DT
通讯作者：
Halperin, DT
影响因子：
3.8
作者：
Allen, S;Meinzen-Derr, L;Haworth, A
通讯作者：
Haworth, A
影响因子：
168.9
作者：
Babiker, A;Darby, S;Schechter, M
通讯作者：
Schechter, M