Can highly active antiretroviral therapy reduce the spread of HIV?: A study in a township of South Africa
Can highly active antiretroviral therapy reduce the spread of HIV?: A study in a township of South Africa
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DOI：
10.1097/00126334-200405010-00010
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发表时间：
2004-05-01
影响因子：
3.6
通讯作者：
Williams, B
中科院分区：
文献类型：
--
作者：
Auvert, B;Males, S;Williams, B
背景：有人呼吁向发展中国家的艾滋病毒感染者大规模提供高效抗逆转录病毒疗法(HAART)。如果要做到这一点，就需要估计在撒哈拉以南非洲艾滋病毒高发区目前需要接受HAART的人数，以及HAART的广泛使用对艾滋病毒传播和传播的影响。目标：估计符合联合抗逆转录病毒治疗的人数比例，并评估在HIV-1高流行率的南非城镇中，根据世界卫生组织(WHO)指南提供HAART对HIV-1传播的潜在影响。设计：在南非约翰内斯堡附近的一个城镇进行一项基于社区的横断面研究，随机抽取约1000名年龄在15~49岁的男性和女性进行调查。参与者接受了HIV-1检测，并测量了他们的CD4(+)细胞计数和血浆HIV-1RNA载量。估计了CD4(+)细胞计数低于200个/mm(3)的人以及根据世卫组织指南有资格接受HAART的人的比例。在这种情况下，抗逆转录病毒药物对艾滋病毒-1传播的潜在影响是通过估计艾滋病毒-1阳性个人参与的伙伴关系中有资格接受抗逆转录病毒治疗的配偶和非配偶伙伴的比例，然后通过计算抗逆转录病毒药物对由于与艾滋病毒-1感染者的性接触而每年传播艾滋病毒-1的风险的潜在影响来确定的。结果：HIV-1总感染率为21.8%(19.2%-24.6%)，其中15-49岁人群中有9.5%(6.1%-14.9%)或2.1%(1.3%-3.3%)符合HAART(95%可信限)。在接下来的3年中，每年有6.3%(4.6%-8.4%)的HIV-1感染者需要开始HAART。在HIV-1阳性的伙伴关系中，只有一小部分配偶伙伴关系(7.6%[3.4%-15.6%])和非配偶伙伴关系(5.7%，[3.0%10.2%])的伴侣的CD4(+)细胞计数低于200个/mm(3)，并将受益于减少传播，因为在HAART下血浆HIV-1RNA载量减少。对HAART对每年HIV-1传播风险的影响的估计表明，这一风险将降低11.9%(7.1%-17.0%)。使用USDHHS指南时，符合HAART条件的HIV-1阳性个体比例达到56.3%(49.1%-63.2%)，HAART对HIV-1年传播风险的影响达到71.8%(64.5%-77.5%)。结论：在WHO指南下，HAART对减少HIV-1性传播的人口影响可能较小，减少HIV-1的传播将取决于进一步加强常规预防工作。如果使用USDHHS指南，HAART的影响将会更大。
Background: Calls have been made for the large-scale delivery of highly active antiretroviral therapy (HAART) to people infected with HIV in developing countries. If this is to be done, estimates of the number of people who currently require HAART in high HIV prevalence areas of sub-Saharan Africa are needed, and the impact of the widespread use of HAART on the transmission and, hence, spread of HIV must be assessed.Objectives: To estimate the proportion of people eligible for combination antiretroviral therapy and to evaluate the potential impact of providing HAART on the spread of HIV-1 under World Health Organization (WHO) guidelines in a South African township with a high prevalence of HIV-1.Design: A community-based cross-sectional study in a township near Johannesburg, South Africa, of a random sample of approximately 1000 men and women aged 15 to 49 years.Methods: Background characteristics and sexual behavior were recorded by questionnaire. Participants were tested for HIV-1, and their CD4(+) cell counts and plasma HIV-1 RNA loads were measured. The proportion of people whose CD4(+) cell count was less than 200 cells/mm(3) and who would be eligible to receive HAART under WHO guidelines was estimated. The potential impact of antiretroviral drugs on the spread of HIV-1 in this setting was determined by estimating among the partnerships engaged in by HIV-1-positive individuals theproportion of spousal and nonspousal partnerships eligible to receive HAART and then by calculating the potential impact of HAART on the annual risk of HIV-1 transmission due to sexual contacts with HIV-1-infected persons. The results were compared with those obtained using United States Department of Health and Human Services (USDHHS) guidelines.Results: The overall prevalence of HIV-1 infection was 21.8% (19.2%-24.6%), and of these people, 9.5% (6.1%-14.9%) or 2.1% (1.3%-3.3%) of all those aged 15 to 49 years would be eligible for HAART (ranges are 95% confidence limits). In each of the next 3 years 6.3% (4.6%-8.4%) of those currently infected with HIV-1 need to start HAART. Among the partnerships in which individuals were HIV-1-positive, only a small proportion of spousal partnerships (7.6% [3.4%-15.6%]) and nonspousal partnerships (5.7%, [3.0%10.2%]) involved a partner with a CD4(+) cell count below 200 cells/mm(3) and would have benefited from the reduction of transmission due to the decrease in plasma HIV-1 RNA load under HAART. Estimates of the impact of HAART on the annual risk of HIV-1 transmission show that this risk would be reduced by 11.9% (7.1%17.0%). When using USDHHS guidelines, the proportion of HIV-1 positive individuals eligible for HAART reached 56.3% (49.1%63.2%) and the impact of HAART on the annual risk of HIV-1 transmission reached 71.8% (64.5%-77.5%).Conclusions: The population impact of HAART on reducing sexual transmission of HIV-1 is likely to be small under WHO guidelines, and reducing the spread of HIV-1 will depend on further strengthening of conventional prevention efforts. A much higher impact of HAART is to be expected if USDHHS guidelines are used.