Potential impact of early antiretroviral therapy on transmission
Potential impact of early antiretroviral therapy on transmission
复制标题
DOI：
10.1097/coh.0b013e328329c5ca
复制
发表时间：
2009-05-01
影响因子：
4.1
通讯作者：
Fisher, Martin
中科院分区：
文献类型：
--
作者：
Pao, David;Pillay, Deenan;Fisher, Martin
在这篇综述中，我们将讨论早期高效抗逆转录病毒治疗（HAART）在个体和人群水平上减少HIV性传播的潜力。我们将重点关注与HAART使用相关的生物学合理性和行为因素，以及可能影响这一战略的干预措施。最近的发现和系统发育研究支持这样的观点，即最近的艾滋病毒感染是一个高度传染性的疾病阶段。越来越多的证据表明，接受完全抑制性HAART治疗的个体将艾滋病毒传播给性伴侣的可能性大大降低，有些人甚至认为这些个体不能传播艾滋病毒。风险行为的变化与高效抗逆转录病毒治疗的可获得性有关，但行为学研究对这些变化的方向和幅度提供了相互矛盾的观察结果。这反过来又使复杂的假设和许多复杂的数学建模研究的结果变得不那么安全。此外，有证据表明，正是那些未确诊的艾滋病毒感染者在很大程度上促进了性传播。在个体水平上，HAART将降低病毒载量，从而降低传染性，尽管是否为零仍然存在争议。在人群层面，如果最近的感染和未确诊的感染继续推动传播，只有在诊断未确诊和识别最近感染方面有所改善的情况下，早期治疗才能改变大流行。
Purpose of reviewIn this review, we will discuss the potential of early highly active antiretroviral therapy (HAART) to reduce the sexual transmission of HIV on an individual and population level. We will focus on the biological plausibility and behavioural factors associated with HAART use and interventions that might influence such a strategy.Recent findingsEmpiric and phylogenetic studies support the view that recent HIV infection is a highly infectious disease stage. Evidence increasingly demonstrates that individuals on fully suppressive HAART are significantly less likely to transmit HIV to sexual partners and some even suggest that such individuals cannot transmit HIV. Changes in risk behaviour are associated with the availability of HAART but behavioural studies offer contradictory observations regarding the direction and magnitude of these changes. This in turn makes the intricate assumptions and therefore outcomes of many complex mathematical modelling studies less secure. Furthermore, there is evidence that it is those individuals with undiagnosed HIV infection who contribute significantly to onward sexual transmission.SummaryAt an individual level, HAART will reduce viral load and, therefore, infectiousness, although whether to zero or not remains controversial. At a population level, if recent infection and undiagnosed infections continue to drive onward transmission, earlier treatment will only alter the pandemic if accompanied by an improvement in diagnosing the undiagnosed and recognizing recent infection.