Control of sexually transmitted diseases for HIV-1 prevention: understanding the implications of the Mwanza and Rakai trials
Control of sexually transmitted diseases for HIV-1 prevention: understanding the implications of the Mwanza and Rakai trials
复制标题
DOI：
10.1016/s0140-6736(00)02336-9
复制
发表时间：
2000-06-03
期刊：
影响因子：
168.9
通讯作者：
Wawer, M
中科院分区：
文献类型：
--
作者：
Grosskurth, H;Gray, R;Wawer, M
在坦桑尼亚的姆万扎和乌干达的拉凯，两个性传播疾病(STD)治疗预防HIV-1感染的随机对照试验出人意料地产生了相反的结果。人口HIV-1发病率的下降与Mwanza改进的STD病例管理有关，但与Rakai的STD大规模治疗无关。在这两项研究中都发现可治愈的性传播疾病有所减少。这些试验在不同的艾滋病毒-1流行环境中测试了不同的干预措施，并使用了不同的评估方法；不同的结果可能是互补的，而不是相互矛盾的。可能的解释包括：艾滋病毒-1流行阶段的不同，这可能会影响艾滋病毒-1的暴露和受感染人口中病毒载量的分布；无法治愈的性传播疾病(如生殖器疱疹)的流行率可能存在差异；对艾滋病毒-1的传播来说，有症状的性传播疾病可能比无症状的性传播疾病更重要；持续提供的服务可能比间歇性大规模治疗更有效地控制快速的性传播疾病再感染。讨论了试验对政策和未来研究议程的影响。
Two randomised controlled trials of sexually transmitted disease (STD) treatment for the prevention of HIV-1 infection, in Mwanza, Tanzania, and Rakai, Uganda, unexpectedly produced contrasting results. A decrease in population HIV-1 incidence was associated with improved STD case management in Mwanza, but was not associated with STD mass treatment in Rakai. Some reductions in curable STDs were seen in both studies. These trials tested different interventions in different HIV-1 epidemic settings and used different evaluation methods; the divergent results may be complementary rather than contradictory. Possible explanations include: differences in stage of the HIV-1 epidemic, which can influence exposure to HIV-1 and the distribution of viral load in the infected population; potential differences in the prevalence of incurable STDs (such as genital herpes); perhaps greater importance of symptomatic than symptomless STDs for HIV-1 transmission; and possibly greater effectiveness of continuously available services than of intermittent mass treatment to control rapid STD reinfection. Implications of the trials for policy and future research agenda are discussed.