High coverage of ART associated with decline in risk of HIV acquisition in rural KwaZulu-Natal, South Africa.
High coverage of ART associated with decline in risk of HIV acquisition in rural KwaZulu-Natal, South Africa.
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DOI：
10.1126/science.1228160
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发表时间：
2013-02-22
期刊：
影响因子：
--
通讯作者：
Newell ML
中科院分区：
文献类型：
--
作者：
Tanser F;Bärnighausen T;Grapsa E;Zaidi J;Newell ML
具有里程碑意义的艾滋病毒预防试验网络（HPTN）052在艾滋病毒不一致的夫妇中进行的试验明确表明，抗逆转录病毒疗法（ART）治疗大大降低了艾滋病毒传播给未感染艾滋病毒的伴侣的可能性。然而，人们一直在激烈辩论，在撒哈拉以南非洲的“现实世界”环境中，是否可以在人口水平上大幅降低艾滋病毒新感染率，因为在那里，稳定的同居伴侣往往不是常态，而且在向大量患者成功和可持续地提供治疗和护理方面存在相当大的业务挑战。我们使用来自非洲最大的基于人群的前瞻性队列研究之一（在南非的农村夸祖鲁-纳塔尔）的数据，对基线时未感染艾滋病毒的16，667名个体进行随访，观察2004年至2011年期间个体的艾滋病毒血清转换。保持其他关键的艾滋病毒风险因素不变，个人感染艾滋病毒的风险显着下降，增加ART覆盖率在周围的当地社区。例如，生活在抗逆转录病毒治疗覆盖率高的社区（所有接受抗逆转录病毒治疗的艾滋病毒感染者中有30%至40%）的未感染艾滋病毒的人感染艾滋病毒的可能性比生活在抗逆转录病毒治疗覆盖率低的社区（所有接受抗逆转录病毒治疗的艾滋病毒感染者中<10%）的人低38%。
The landmark HIV Prevention Trials Network (HPTN) 052 trial in HIV-discordant couples demonstrated unequivocally that treatment with antiretroviral therapy (ART) substantially lowers the probability of HIV transmission to the HIV-uninfected partner. However, it has been vigorously debated whether substantial population-level reductions in the rate of new HIV infections could be achieved in “real-world” sub-Saharan African settings where stable, cohabiting couples are often not the norm and where considerable operational challenges exist to the successful and sustainable delivery of treatment and care to large numbers of patients. We used data from one of Africa’s largest population-based prospective cohort studies (in rural KwaZulu-Natal, South Africa) to follow up a total of 16,667 individuals who were HIV-uninfected at baseline, observing individual HIV seroconversions over the period 2004 to 2011. Holding other key HIV risk factors constant, individual HIV acquisition risk declined significantly with increasing ART coverage in the surrounding local community. For example, an HIV-uninfected individual living in a community with high ART coverage (30 to 40% of all HIV-infected individuals on ART) was 38% less likely to acquire HIV than someone living in a community where ART coverage was low (<10% of all HIV-infected individuals on ART).
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影响因子：
168.9
作者：
Montaner, Julio S. G.;Lima, Viviane D.;Barrios, Rolando;Yip, Benita;Wood, Evan;Kerr, Thomas;Shannon, Kate;Harrigan, P. Richard;Hogg, Robert S.;Daly, Patricia;Kendall, Peny
通讯作者：
Kendall, Peny
影响因子：
168.9
作者：
Tanser, Frank;Baernighausen, Till;Hund, Lauren;Garnett, Geoffrey P.;McGrath, Nuala;Newell, Marie-Louise
通讯作者：
Newell, Marie-Louise
影响因子：
7.7
作者：
Houlihan, Catherine F.;Bland, Ruth M.;Newell, Marie-Louise
通讯作者：
Newell, Marie-Louise
影响因子：
2
作者：
Budtz-Jorgensen, E;Keiding, N;White, RF
通讯作者：
White, RF
影响因子：
3.8
作者：
Barnighausen, Till;Tanser, Frank;Newell, Marie-Louise
通讯作者：
Newell, Marie-Louise