Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model
Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model
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DOI：
10.1016/s0140-6736(08)61697-9
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发表时间：
2009-01-03
期刊：
影响因子：
168.9
通讯作者：
Williams, Brian G.
中科院分区：
文献类型：
--
作者：
Granich, Reuben M.;Gilks, Charles F.;Williams, Brian G.
背景截至2007年底，全球约有300万人正在接受抗逆转录病毒疗法(ART)，但估计仍有670万人需要治疗，2007年又有270万人感染艾滋病毒。预防工作可能会减少艾滋病毒的发病率，但不太可能根除这种疾病。方法利用数学模型探讨了每年对我们检测病例社区中的所有人(15岁及以上)进行HIV检测并在被诊断为HIV阳性后立即开始ART治疗对病例复制数量(随机模型)和HIV流行的长期动态(确定性传播模型)的影响。我们使用南非的数据作为普遍流行的测试案例，并假设所有的艾滋病毒传播都是异性恋。发现所研究的策略可以在5年内极大地加速从目前的流行阶段向消除阶段的过渡，在目前的流行阶段，大多数携带艾滋病毒的成年人没有接受抗逆转录病毒治疗。到2016年，或在全面实施该战略的10年内，可将艾滋病毒发病率和死亡率降至每年每1000人1例以下，并在50年内将艾滋病毒流行率降至1%以下。我们估计，到2032年，当前战略和理论战略的年成本都将达到17亿美元；然而，在此之后，当前战略的成本将继续增加，而理论战略的成本将下降。解释普遍自愿艾滋病毒检测和立即抗逆转录病毒治疗，与目前的预防方法相结合，可能对严重的全面性艾滋病毒/艾滋病流行产生重大影响。这种方法值得进一步的数学建模、研究和广泛的咨询。
Background Roughly 3 million people worldwide were receiving antiretroviral therapy (ART) at the end of 2007, but an estimated 6.7 million were still in need of treatment and a further 2.7 million became infected with HIV in 2007. Prevention efforts might reduce HIV incidence but are unlikely to eliminate this disease. We investigated a theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, and examined the conditions under which the HIV epidemic could be driven towards elimination.Methods We used mathematical models to explore the effect on the case reproduction number (stochastic model) and long-term dynamics of the HIV epidemic (deterministic transmission model) of testing all people in our test-case community (aged 15 years and older) for HIV every year and starting people on ART immediately after they are diagnosed HIV positive. We used data from South Africa as the test case for a generalised epidemic, and assumed that all HIV transmission was heterosexual.Findings The studied strategy could greatly accelerate the transition from the present endemic phase, in which most adults living with HIV are not receiving ART, to an elimination phase, in which most are on ART, within 5 years. it could reduce HIV incidence and mortality to less than one case per 1000 people per year by 2016, or within 10 years of full implementation of the strategy, and reduce the prevalence of HIV to less than 1% within 50 years. We estimate that in 2032, the yearly cost of the present strategy and the theoretical strategy would both be US$1.7 billion; however, after this time, the cost of the present strategy would continue to increase whereas that of the theoretical strategy would decrease.Interpretation Universal voluntary HIV testing and immediate ART, combined with present prevention approaches, could have a major effect on severe genralised HIV/AIDS epidemics. This approach merits further mathematical modelling, research, and broad consultation.Funding None.