Tracking the progress of HIV: the impact of point-of-care tests on antiretroviral therapy.
Tracking the progress of HIV: the impact of point-of-care tests on antiretroviral therapy.
复制标题
跟踪艾滋病毒的进展：护理点测试对抗逆转录病毒疗法的影响。
DOI：
10.2147/clep.s37069
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发表时间：
2013-09-26
影响因子：
3.9
通讯作者：
Cooke GS
中科院分区：
文献类型：
--
作者：
Reid SD;Fidler SJ;Cooke GS
自发现艾滋病毒（导致艾滋病的病毒）以来，现在已经过去了大约30年。在此期间，有7 000多万人感染，约3 500万人死亡。目前艾滋病毒/艾滋病感染者大多数生活在低收入和中等收入国家，撒哈拉以南非洲承受着这一全球性疾病的不成比例的负担。在高收入国家，抗逆转录病毒疗法的采用大大降低了与艾滋病毒有关的发病率和死亡率。目前预计接受抗逆转录病毒治疗的患者的预期寿命接近正常，治疗在预防新感染方面的作用日益得到认可。在低收入和中等收入国家，治疗现在更加普及，需要抗逆转录病毒疗法的人中约有一半目前正在接受治疗。用于筛查、诊断、治疗启动和治疗效果监测的基于实验室的诊断对于管理疾病和减少每年新感染的数量至关重要。护理点艾滋病毒快速检测的采用改变了这一流行病，特别是在低收入和中等收入国家。这些护理点检测首次允许在实验室外快速识别受感染者，他们可以接受咨询和治疗，对于孕妇，还允许及时启动抗逆转录病毒疗法，以减少垂直传播的风险。尽管即使在没有实验室监测的情况下，抗逆转录病毒疗法也能显著提高生存率，但对接受抗逆转录病毒疗法的艾滋病毒感染者及其伴侣进行长期管理，对于确保成功抑制病毒至关重要。在许多艾滋病毒流行率高、资源贫乏的环境中，疾病负担对当地实验室有效监测接受抗逆转录病毒治疗者的能力提出了挑战。这些新的病毒载量和CD 4的即时检测有望进一步改变这种疾病，并改变低收入和中等收入国家的治疗模式。
It is now around 30 years since the discovery of HIV, the virus that causes AIDS. More than 70 million people have been infected in that time and around 35 million have died. The majority of those currently living with HIV/AIDS are in low- and middle-income countries, with sub-Saharan Africa bearing a disproportionate burden of the global disease. In high-income countries, the introduction of antiretroviral therapy (ART) has drastically reduced the morbidity and mortality associated with HIV. Patients on ART are now predicted to have near-normal life expectancy and the role of treatment is increasingly recognized in preventing new infections. In low- and middle-income countries, treatment is now more widely available and around half of those who need ART are currently receiving it. Early diagnosis of HIV is essential if ART is to be optimally implemented. Lab-based diagnostics for screening, diagnosis, treatment initiation, and the monitoring of treatment efficacy are critical in managing the disease and reducing the number of new infections each year. The introduction of point-of-care HIV rapid tests has transformed the epidemic, particularly in low- and middle-income countries. For the first time, these point-of-care tests allow for the rapid identification of infected individuals outside the laboratory who can undergo counseling and treatment and, in the case of pregnant women, allow the timely initiation of ART to reduce the risk of vertical transmission. Although survival is markedly improved with ART even in the absence of laboratory monitoring, long-term management of people living with HIV on ART, and their partners, is essential to ensure successful viral suppression. The burden of disease in many resource-poor settings with high HIV prevalence has challenged the ability of local laboratories to effectively monitor those on ART. Diagnostics used to initiate and monitor treatment are now moving out of the laboratory and into the field. These new point-of-care tests for viral load and CD4 are poised to further transform the disease and shift the treatment paradigm in low- and middle-income countries.