The new role of antiretrovirals in combination HIV prevention: a mathematical modelling analysis
The new role of antiretrovirals in combination HIV prevention: a mathematical modelling analysis
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DOI：
10.1097/qad.0b013e32835ca2dd
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发表时间：
2013-01-28
期刊：
影响因子：
3.8
通讯作者：
Hallett, Timothy B.
中科院分区：
文献类型：
--
作者：
Cremin, Ide;Alsallaq, Ramzi;Hallett, Timothy B.
背景和目的：抗逆转录病毒药物可以减少未感染者的艾滋病毒感染（如暴露前预防：PrEP），并减少感染者之间的进一步传播（如抗逆转录病毒治疗：ART）。我们估计了基于抗逆转录病毒的艾滋病毒预防策略的潜在影响和成本效益。设计和方法：我们开发并分析了一个避孕套使用水平相对较低的高流行环境的数学模型。我们估计了各种PrEP干预措施的预防影响和成本，假设PrEP支出固定；从流行病学影响和成本方面调查了PrEP和早期ART的最佳作用；并系统地探讨早期抗逆转录病毒治疗和预防措施与医疗男性包皮环切服务相结合的影响；预防艾滋病毒传播。结果：除非成本大幅降低，否则PrEP干预不太可能大幅降低艾滋病毒发病率。就避免感染和获得质量调整生命年而言，在人口层面上，通过及早向更多感染者提供抗逆转录病毒治疗，而不是向未感染者提供预防措施，可以实现最大的成本效益。然而，仅靠早期抗逆转录病毒治疗不能将艾滋病毒发病率降低到非常低的水平，除了早期抗逆转录病毒治疗外，还可以经济有效地使用预防措施以进一步降低发病率。如果将包皮环切术、早期抗逆转录病毒治疗和预防措施结合起来实施，并达到雄心勃勃的覆盖水平，则可使艾滋病毒发病率大幅下降，但不能完全阻止传播。结论：以行之有效的干预措施为基础，采取联合预防措施，是实现预防进展和遏制艾滋病毒传播的最佳机会。[j]中国艾滋病防治杂志，2013,27 (4):447-458
Background and objectives: Antiretroviral drugs can reduce HIV acquisition among uninfected individuals (as pre-exposure prophylaxis: PrEP) and reduce onward transmission among infected individuals (as antiretroviral treatment: ART). We estimate the potential impact and cost-effectiveness of antiretroviral-based HIV prevention strategies.Design and methods: We developed and analysed a mathematical model of a hyperendemic setting with relatively low levels of condom use. We estimated the prevention impact and cost of various PrEP interventions, assuming a fixed amount of spending on PrEP; investigated the optimal role of PrEP and earlier ART in terms of epidemiological impact and cost; and systematically explored the impact of earlier ART and PrEP, in combination with medical male circumcision services; on HIV transmission.Results: A PrEP intervention is unlikely to generate a large reduction in HIV incidence, unless the cost is substantially reduced. In terms of infections averted and quality adjusted life years gained, at a population-level maximal cost-effectiveness is achieved by providing ART to more infected individuals earlier rather than providing PrEP to uninfected individuals. However, early ART alone cannot reduce HIV incidence to very low levels and PrEP can be used cost-effectively in addition to earlier ART to reduce incidence further. If implemented in combination and at ambitious coverage levels, medical male circumcision, earlier ART and PrEP could produce dramatic declines in HIV incidence, but not stop transmission completely.Conclusion: A combination prevention approach based on proven-efficacy interventions provides the best opportunity for achieving the much hoped for prevention advance and curbing the spread of HIV. (C) 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins AIDS 2013, 27: 447-458