Seek and Treat for Optimal Outcomes and Prevention in HIV & AIDS in IDU

说明（由申请人提供）：艾滋病毒/艾滋病在全世界继续迅速蔓延。这种情况很可能继续存在，因为1)艾滋病毒无法治愈，2)预防被忽视，3)预防性疫苗仍然难以找到。相比之下，在治疗方面已经取得了巨大的进步。自1996年以来，高效抗逆转录病毒疗法（HAART）已将艾滋病转变为一种可控制的慢性疾病。HAART可阻止HIV复制，从而将血浆病毒水平降低到无法检测的水平（<50 c/mL）。这将导致持续的免疫恢复和接近正常的健康。HAART也被证明可以降低精液和阴道分泌物中的艾滋病毒水平。因此，人们越来越关注HAART通过降低接受治疗者的传染性来直接预防艾滋病毒传播的可能作用。支持“高效抗逆转录病毒疗法作为预防手段”的证据首先出现在纵向传播研究中，在纵向传播研究中，如果采用高效抗逆转录病毒疗法，艾滋病毒从受感染的母亲传染给她的孩子的情况最终变得极为罕见。在HIV血清不一致的异性恋夫妇中，以及在台湾、旧金山的人群水平研究和我们在加拿大不列颠哥伦比亚省的研究中，偶然发现了HAART对降低HIV传播的可能影响。因此，我们建议前瞻性地检验“HAART作为预防”的假设，并特别关注IDU。具体而言，我们建议测试：1)扩大HAART在IDU中的覆盖范围将导致人口中新发艾滋病毒感染人数的减少，包括但不限于IDU；2)扩大抗逆转录病毒疗法在注射吸毒者中的覆盖范围，将导致注射吸毒者中艾滋病毒/艾滋病不良健康结果的减少。这项名为“寻求和治疗注射吸毒者中艾滋病毒和艾滋病的最佳结果和预防”的建议是一项开创性和创新性的研究假设，对控制全球艾滋病毒流行具有重要影响。

DESCRIPTION (provided by applicant): The HIV/AIDS epidemic continues to grow rapidly, throughout the world. This is likely to remain so because i) HIV cannot be cured, ii) prevention is neglected and iii) a preventive vaccine remains elusive. In contrast, on the therapeutics front there has been tremendous progress. Since 1996, highly active antiretroviral therapy (HAART) has transformed AIDS into a chronic manageable illness. HAART stops HIV replication, therefore turning plasma viral levels to undetectable levels (<50 c/mL). This leads to a sustained immune recovery and near normal health. HAART has also been shown to decrease HIV levels in semen and vaginal secretions. As a result there has been growing interest regarding the possible role of HAART in directly preventing HIV transmission by decreasing infectiveness of those on treatment. Supportive evidence for "HAART as Prevention" first emerged in vertical transmission studies where, ultimately, HIV transmission from the infected mother to her child has become exceedingly rare if HAART is in place. A possible effect of HAART on decreasing HIV transmission has been incidentally observed in HIV serodiscordant heterosexual couples and separately in population-level studies from Taiwan, San Francisco and in our own study in British Columbia, Canada. We therefore propose to prospectively test the "HAART as Prevention" hypothesis, with a special focus on IDU. Specifically we propose to test that: 1) expanded HAART coverage among IDU will lead to a decrease in the number of new HIV infections within the population, including but not restricted to IDU; and 2) expanded HAART coverage among IDU, will lead to a decrease in adverse HIV/AIDS health outcomes among IDU. This proposal, named "Seek and Treat for Optimal Outcomes and Prevention in HIV & AIDS in IDU", represents both a groundbreaking and innovative research hypothesis with important consequences for the control of the global HIV epidemic.