Modeling UNAIDS treatment targets for China.
Modeling UNAIDS treatment targets for China.
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DOI：
10.1097/qad.0000000000003571
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发表时间：
2023-06
期刊：
影响因子：
3.8
通讯作者：
S. Blower;Justin T. Okano;James S. Kahn
中科院分区：
文献类型：
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作者：
S. Blower;Justin T. Okano;James S. Kahn
联合国艾滋病规划署制定了到2030年实现的治疗目标，这是确保在世界范围内成功消除艾滋病毒所必需的：具体来说，诊断95%的艾滋病毒感染者，治疗95%的诊断者，并在95%的治疗者中实现病毒抑制[1]。在这期艾滋病的一项有趣的研究中，Shen等。[2]建立中国艾滋病疫情传播动态模型，其中实现的治疗目标仅为71%、80%和65%。正如作者所指出的，高流失率是取得成功的主要障碍。作者预测了当扩大治疗时，损耗对传播的影响，发展耐药菌株的风险（即获得性耐药），耐药菌株的传播（即传播耐药）和HIV相关死亡率。[2]使用广西疾病预防控制中心2008年至2018年收集的年度艾滋病毒/艾滋病监测数据对他们的模型进行参数化。他们建立了一个基于核苷逆转录酶抑制剂（nRTIs），非NRTIs（nnRTI）和蛋白酶抑制剂的单一治疗方案;一种耐药性菌株的发展，随后被传播，被认为是对所有三类耐药。他们预测了在8年期间（2022-2030年）同时增加自然减员率和治疗率的影响。他们的结果表明，某些比率的组合降低了传播的耐药性，新感染的累积数量和艾滋病毒相关的死亡;然而，其他组合增加了这些数量。值得注意的是，他们表明，在某些情况下，一个小的增加损耗可以抵消治疗扩展的好处。因此，他们得出结论，“减少
UNAIDS has set treatment targets, to be achieved by 2030, that are necessary to ensure the successful elimination of HIV worldwide: specifically, to diagnose 95% of people with HIV (PHIV), to treat 95% of the diagnosed, and to attain viral suppression in 95% of the treated [1]. In an interesting study in this issue of AIDS, Shen et al.[2] model the transmission dynamics of the HIV epidemic in China where the achieved treatment targets are only 71%, 80%, and 65%. As the authors note, a high rate of attrition is a major barrier to achieving success. The authors predict the impact of attrition–when expanding treatment–on transmission, the risk of developing drug-resistant strains (ie acquired resistance), the transmission of drug-resistant strains (ie transmitted resistance), and HIV-related mortality.Shen et al.[2] parameterized their model using annual HIV/AIDS surveillance data that were collected between 2008 and 2018 by the Guangxi Center for Disease Control and Prevention. They modeled a single treatment regimen based on nucleoside reverse transcriptase inhibitors (nRTIs), non-NRTIs (nnRTI), and protease inhibitors; the one strain of drug-resistance that developed, and was subsequently transmitted, was assumed to be resistant to all three classes. They predicted the impact of simultaneously increasing both the attrition rate and the treatment rate over an 8-year period: 2022–2030. Their results showed that some combinations of rates decreased transmitted resistance, the cumulative number of new infections, and HIV-related deaths; however, other combinations increased these quantities. Notably, they showed that–in some cases–a small increase in attrition could offset the benefits of treatment expansion. Consequently, they concluded that ‘reducing