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

描述(申请人提供)：艾滋病毒/艾滋病在全世界范围内继续快速增长。这种情况可能会持续下去，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，在治疗学方面取得了巨大的进步。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慢性可控疾病。HAART可阻止艾滋病毒复制，从而将血浆病毒水平降至无法检测到的水平(&lt；50毫升)。这会导致持续的免疫恢复和接近正常的健康。HAART还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，人们对HAART通过降低接受治疗的人的传染性直接预防艾滋病毒传播的可能作用越来越感兴趣。支持“HAART作为预防”的证据首先出现在垂直传播研究中，在这些研究中，如果HAART到位，艾滋病毒从受感染的母亲传染给她的孩子最终变得极其罕见。HAART在减少HIV传播方面的可能效果已经在HIV血清不一致的异性伴侣中偶然观察到，并分别在台湾、旧金山和我们自己在加拿大不列颠哥伦比亚省的研究中观察到。因此，我们建议前瞻性地检验“HAART作为预防”的假说，特别关注IDU。具体地说，我们建议测试：1)扩大注射吸毒者的HAART覆盖范围将导致人群中新感染艾滋病毒的人数减少，包括但不限于注射吸毒者；以及2)扩大注射吸毒者的HAART覆盖范围将导致注射吸毒者艾滋病毒/艾滋病不良健康后果的减少。这项名为“在注射吸毒者中寻求和治疗艾滋病毒和艾滋病的最佳结果和预防”的建议，代表了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.