Does ART prevent HIV transmission among MSM?
Does ART prevent HIV transmission among MSM?
复制标题
ART可以防止MSM之间的HIV传播吗？
DOI：
10.1097/qad.0b013e328355713d
复制
发表时间：
2012-11-28
期刊：
影响因子：
--
通讯作者：
Cohen MS
中科院分区：
文献类型：
--
作者：
Muessig KE;Smith MK;Powers KA;Lo YR;Burns DN;Grulich AE;Phillips AN;Cohen MS
目的：回顾证据抗逆转录病毒治疗预防艾滋病毒传播的男男性接触者。方法：我们回顾了研究，评估生物学的可行性，病毒抑制性抗逆转录病毒治疗（ART）减少艾滋病毒感染通过肛门性交和流行病学证据是否ART已发挥作用，在减少艾滋病毒的发病率在男男性接触者。结果：虽然男男性接触者之间的ART治疗可能提供一些预防性的好处，它是未知的，它是否会减少艾滋病毒感染通过肛门性交到相同的程度，通过阴茎-阴道性交。需要对特定抗逆转录病毒药物在胃肠道中的药代动力学特性进行进一步研究。在引入和扩大抗逆转录病毒疗法之前和之后，对男男性行为者的风险行为和艾滋病毒发病率的估计表明，抗逆转录病毒疗法的人群保护效益可能会因一些因素而减弱，最值得注意的是，持续或增加无安全套肛交的频率和其他性传播感染（STI）的发病率。需要更多的研究对艾滋病病毒的性风险行为和传播的影响，在北美，西欧，和Australia.Conclusion发达国家以外的男男性接触者之间的ART：作为预防男男性接触者的治疗的好处是非常合理的，但不确定。面对这些未知因素，应在包括早期诊断、扩大性传播感染治疗以及结构和行为干预在内的综合预防战略中考虑早期开始抗逆转录病毒治疗的治疗指南。
Objective:To review the evidence for antiretroviral ‘treatment as prevention’for HIV transmission among MSM.Methods:We reviewed studies that assess the biological plausibility that virally suppressive antiretroviral therapy (ART) reduces HIV infectiousness via anal intercourse and the epidemiologic evidence of whether ART has played a role in attenuating HIV incidence among MSM.Results:Although ART treatment among MSM is likely to provide some preventive benefit, it is unknown whether it will reduce HIV infectiousness via anal intercourse to the same extent as via penile–vaginal intercourse. Additional research is needed on the pharmacokinetic properties of specific antiretroviral agents in the gastrointestinal tract. Estimates of risk behaviors and the incidence of HIV among MSM before and after the introduction and expansion of ART suggest that the population-level protective benefits of ART may be attenuated by a number of factors, most notably, continuing or increasing frequency of condomless anal intercourse and incidence of other sexually transmitted infections (STIs). Additional studies are needed on the impact of ART on HIV sexual risk behaviors and transmission among MSM outside of developed countries in North America, western Europe, and Australia.Conclusion:The benefits of treatment as prevention for MSM are highly plausible, but not certain. In the face of these unknowns, treatment guidelines for earlier ART initiation should be considered within a combination prevention strategy that includes earlier diagnosis, expanded STI treatment, and structural and behavioral interventions.