The clinical outcomes, response to treatment and epidemic dynamics of HIV-1 in the UK

英国艾滋病毒携带者的特征正在发生变化，艾滋病毒携带者中女性的数量要多得多。艾滋病毒的治疗现在非常有效，许多感染该病毒的人能够过上几乎正常的生活。结果，不仅感染艾滋病毒的人口变得越来越老，而且许多妇女都开始组建自己的家庭。即使这些妇女还不需要为了自己的健康而接受治疗，她们也可能会接受短期的治疗，以防止她们的婴儿感染艾滋病毒。这种治疗非常有效，现在英国每年只有很少一部分感染艾滋病毒的婴儿出生。对于同时感染丙型或乙肝病毒的人，治疗可能会进一步复杂化？与仅感染艾滋病毒的人相比，这些人可能需要更早的治疗和/或不同的药物组合。尽管治疗有好处，但这些药物仍可能偶尔对个人无效。这可能是因为个体对药物产生了副作用，或者他们发现很难每天在完全相同的时间服用药物。当治疗失败时，病毒可能会对患者正在接受的药物产生抗药性，这可能会对他们未来的治疗选择产生连锁反应。因此，医生们已经开始改变他们治疗艾滋病毒感染者的方式；例如，可能会更早开始治疗，可能会使用不同的药物组合，以降低副作用的风险，同时将患者S病毒产生抗药性的风险降至最低。为了规划未来对这些人的护理，我们需要监测艾滋病毒感染者使用治疗的情况以及接受治疗的人的结果。自2001年以来，英国正在进行的两项大型研究--英国CHIC研究和英国人类发展研究--一直在监测艾滋病毒感染者的结果(例如，治疗的使用、艾滋病事件、死亡、耐药性的发展)。这项提议要求提供资金，以继续扩大和监测这些群体，以便他们提供的信息仍然及时和准确。除了监测结果，我们还计划调查怀孕期间接受治疗是否对母亲S的健康有任何长期影响，以及感染乙型或丙型肝炎是否会加速艾滋病毒疾病的进展，或减少治疗的益处。

The characteristics of individuals with HIV in the UK are changing with a much greater number of those living with HIV being women. Treatments for HIV are now very effective and many people infected with the virus are able to live almost normal lives. As a result, not only is the HIV-infected population growing older, but many of the women are starting their own families. Even if these women do not yet require treatment for their own health, they may be treated for short periods of time to prevent their babies from becoming infected with HIV. This treatment is very effective and only a very small number of HIV-infected babies are now born in the UK each year. Treatment may be further complicated among individuals who are also infected with hepatitis C or B virus ? these individuals may require earlier treatment and/or different drug combinations than those who are only infected with HIV. Despite the benefits of treatment, the drugs may still occasionally fail in an individual. This may be because the individual develops side effects to the drugs, or that they find it difficult to take their drugs at exactly the same time every day. When treatments fail, the virus may become resistant to the drugs that the patient is receiving, and this may have knock-on effects for their future treatment choices. Consequently, doctors have started to change the way in which they treat HIV-infected people; for example, treatment may be started earlier and different drug combinations may be used which aim to reduce the risk of side effects, whilst minimising the risk that a patient?s virus will become resistant. In order to plan the future care for these individuals, we need to monitor the use of treatment in HIV-infected persons, and the outcomes of those who receive it. Two large ongoing studies in the UK, the UK CHIC Study and the UK HDRD, have been monitoring outcomes (e.g. use of treatment, AIDS events, deaths, development of resistance) in HIV-infected persons since 2001. This proposal requests funding to continue to expand and monitor these cohorts so that the information they provide remains timely and accurate. In addition to monitoring outcomes, we also plan to investigate whether treatment received during pregnancy has any long-term effects on the mother?s health, and whether infection with hepatitis B or C accelerates the progression of HIV disease, or reduces the benefits of treatments.