5月26日，美国研究人员公布的研究成果显示，常用于治疗艾滋病的鸡尾酒疗法还可以显着降低艾滋病病毒的传播风险。
华盛顿大学、弗雷德哈钦森癌症研究中心等机构的研究人员对非洲7国的3381对异性伴侣进行了研究，每对伴侣中只有一人的艾滋病病毒检测结果呈阳性。研究开始时，他们接受了艾滋病预防知识的咨询，并接受了如何安全进行性行为的培训。研究过程中，349名病毒感染者接受鸡尾酒疗法治疗，其他3032名感染者接受安慰剂治疗。病毒感染者的伴侣每3个月接受一次血液检测，以确定他们是否受到感染。
研究显示，两年后，病毒感染者的伴侣中仍有103人感染了艾滋病病毒，不过其中只有一人的伴侣接受鸡尾酒疗法治疗。也就是说，接受鸡尾酒疗法治疗的感染者将病毒传播给伴侣的风险降低了约92％。
这项研究结果已发表在英国《柳叶刀》杂志上。研究人员认为，这些结果提供了鸡尾酒疗法可降低艾滋病病毒传播风险的“迄今最强的证据”，其原因在于鸡尾酒疗法联合使用多种抗逆转录病毒药物，可降低艾滋病病毒感染者血液中的病毒浓度，从而降低其传染能力。
原文出处：
The Lancet doi:10.1016/S0140-6736(10)60705-2
Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis
Dr Deborah Donnell PhD a b , Jared M Baeten MD b c d, James Kiarie MBChB b f, Katherine K Thomas MS b, Wendy Stevens MBBCh g, Craig R Cohen MD i, James McIntyre MBBCh h, Jairam R Lingappa MD b c e, Connie Celum MD b c d, for the Partners in Prevention HSV/HIV Transmission Study Team
Background
High plasma HIV-1 RNA concentrations are associated with increased risk of HIV-1 transmission. Initiation of antiretroviral therapy (ART) reduces plasma HIV-1 concentrations. We aimed to assess the effect of ART use by patients infected with HIV-1 on risk of transmission to their uninfected partners.
Methods
Participants in our prospective cohort analysis were from a randomised placebo-controlled trial that enrolled heterosexual African adults who were seropositive for both HIV-1 and herpes simplex virus type 2, and their HIV-1 seronegative partners. At enrolment, HIV-1 infected participants had CD4 counts of 250 cells per μL or greater and did not meet national guidelines for ART initiation; during 24 months of follow-up, CD4 counts were measured every 6 months and ART was initiated in accordance with national guidelines. Uninfected partners were tested for HIV-1 every 3 months. The primary outcome was genetically-linked HIV-1 transmission within the study partnership. We assessed rates of HIV-1 transmission by ART status of infected participants.
Findings
3381 couples were eligible for analysis. 349 (10%) participants with HIV-1 initiated ART during the study, at a median CD4 cell count of 198 (IQR 161―265) cells per μL. Only one of 103 genetically-linked HIV-1 transmissions was from an infected participant who had started ART, corresponding to transmission rates of 037 (95% CI 009―204) per 100 person-years in those who had initiated treatment and 224 (184―272) per 100 person-years in those who had not―a 92% reduction (adjusted incidence rate ratio 008, 95% CI 000―057, p=0004). In participants not on ART, the highest HIV-1 transmission rate (879 per 100 person-years) was from those with CD4 cell counts lower than 200 cells per μL. In couples in whom the untreated HIV-1 infected partner had a CD4 cell count greater than 200 cells per μL, 66 (70%) of 94 transmissions occurred when plasma HIV-1 concentrations exceeded 50 000 copies per mL.
Interpretation
Low CD4 cell counts and high plasma HIV-1 concentrations might guide use of ART to achieve an HIV-1 prevention benefit. Provision of ART to HIV-1 infected patients could be an effective strategy to achieve population-level reductions in HIV-1 transmission.
Funding
Bill " Melinda Gates Foundation; US National Institutes of Health.
