ARV治疗可显著降低HIV异性恋间传播

　一项多国参与的研究发现HIV感染者早期接受ARV治疗，可将HIV传染至其性伴侣的风险降低96%，这一结果有很强的政策性意义。
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! }4 A0 ~$ S0 h1 b　　美国国家过敏性与传染性病研究所NIAID发起了这项为期六年的研究，其负责人Anhony Fauci表示，该发现为艾滋早期治疗可带来多层面效益提供了新证据。

1 `1 g9 g  @. O+ q　　NIAID已为这项研究耗资7300万美金，并计划为该项目继续提供4年资助。一个独立监查小组的中期分析使得该机构提前终止该项目并公布研究结果。
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# J; {% ~* I3 _9 o　　该研究由艾滋病预防实验网HPTN在9个国家13处地点展开，共招募1763对受试对象(其中97%为异性恋，开始仅一方感染HIV)。HIV阳性者之前未接受ARV治疗，CD4细胞计数介于340-550/ml(正常值为高于600)。受试对象中一半立刻接受治疗，另一半直到CD4计数低于250或出现AIDS相关症状时才开始ARV治疗。向每个人免费提供免费避孕套和性咨询，并为其他性传播疾病提供免费治疗。

　　中期分析发现39人被感染，其中28例经基因手段检测证实与其长期性伴有关。28例感染者中，除一人外，均属等待治疗组。之前也有观察性研究显示ARV治疗可预防异性恋人群中HIV经性途径传播，但该研究首次利用随机对照临床实验证实这一结果。北卡罗来纳大学的研究人员Mike Cohen和主持该研究的Chapel Hill说：这仅适用于异性恋人群。Cohen还表示他们曾希望纳入男性同性恋，但很少有人志愿加入。
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! F. ~" ~* k3 g2 Z　　尽管结果大多是意料之中----ARV可降低感染者HIV水平，但ARV的预防作用超过了研究设计者们的预期。政策制定者们希望这一发现带来巨大影响。联合国艾滋病规划署负责人Michel Sidibe说：这个消息并没有令我感到吃惊，但它可改变对AIDS的态度。他表示，在目前全球1500万急需治疗的HIV感染者中只有三分之一可获得治疗药物的情况下，这一结果将帮助平息在是否值得投资ARV将其作为预防手段方面的争论。他说：把治疗和预防分开来是不现实的。治疗可减少新发感染，因此使治疗价值增加。
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　　目前WHO颁布的治疗指南建议为每个CD4计数少于350的患者提供治疗。多数发达国家的治疗指南建议在350-500间开始治疗，但实际上，无论CD4计数如何，有钱或有保险患者可随时开始治疗。Sidibe表示他希望这一结果能促使药企降低ARV价格，以满足药物需求增长的需要。他还期望形成新的合作以共同呼吁增加相关资助，并希望在下月纽约举办的联合国艾滋病问题高级别会议中重点导论这一发现。
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　　但有些HIV/AIDS支持者们怀疑对这一好消息能否产生正确的回应。华盛顿U.S. advocacy for Health GAP负责人Matthew Kavanagn表示美国政府的PEPFAR项目(为发展中国家提供一半所需ARV药物)目前没有扩大规模的计划。他说：对我来说，PEPFAR和其他机构没有推出相应计划是疯狂的。美国可能只是想走出来说，我们有了一个惊人的发现，让全世界为之欢呼吧。
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' j% r6 h& G) h- Q: u# T　　Kavanagh还表示向贫穷国家提供另一半AIDS治疗药物的组织(Global Fund to Fight AIDS, Tuberculosis and Malaria)获得的资金也远远不够，他说：如果再不强调必须不计成本地扩大预防和治疗规模，我们将目睹命运的倒退，科学也将无法得到充分的利用。

　　原文：

　　A multicountry study has found that HIV-infected people who start antiretroviral (ARV) treatment at earlier stages of the disease lowered their risk of transmitting the virus to their sexual partners by 96%. The results have major policy implications and “add yet again to the armamentarium of data that indicate the multifaceted benefits of early treatment,” said Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases (NIAID), which sponsored the 6-year study.

　　NIAID, which spent $73 million on the trial, had planned to fund it for another 4 years, but an interim analysis by an independent monitoring group led the institute to pull the plug early and announce the results. Run by the HIV Prevention Trials Network (HPTN) at 13 sites in nine countries, the study recruited 1763 couples (97% heterosexual) in which only one partner was infected with the AIDS virus at the start. None of the HIV-positive people had taken ARVs, and all had CD4 counts that ranged from 350 to 550 per milliliter (normal is above 600). Half the participants received immediate treatment, and the other half did not start ARVs until their CD4 count dropped to 250 or they developed an AIDS-related symptom. Everyone received free condoms, safe sex counseling, and treatment for other sexually transmitted diseases.
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. N: Y% t/ V0 Z　　The interim analysis found that 39 people had become infected, and 28 cases were linked by genetic tests to their regular partners. Of those 28, all but one had a partner in the group that waited to start treatment. Earlier observational studies had shown a similar impact of ARVs reducing sexual transmission in heterosexual couples, but this was the first to demonstrate the prevention power of the drugs in a randomized, controlled clinical trial. “This applies exclusively to heterosexual couples,” cautioned Mike Cohen, a researcher at the University of North Carolina, Chapel Hill, who headed the so-called HPTN 052 study. Cohen noted that they had hoped to include men who have sex with men in the study, but few volunteered to participate.
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　　Although the finding was largely expected—ARVs, after all, reduce the level of HIV in infected people—the prevention power of the drug was greater than the study designers initially anticipated, and policymakers hope it will have a major impact. “It’s information that is not really taking me by surprise, but it’s a game-changer in the AIDS response,” says Michel Sidibé, who heads the Joint United Nations Programme on HIV/AIDS. Sidibé says the results should help put to rest debates about the worthiness of spending money on ARVs as prevention when only one-third of the 15 million HIV-infected people in the world who need treatment for their own immediate health have access to drugs. “The divorce between treatment and prevention is not real,” he says. “Treatment can reduce the number of new infections, which can increase the value of treatment.”

# Z, I3 d1 Z! X6 E/ Q! R) c0 L　　Current treatment guidelines issued by the World Health Organization call for offering treatment to everyone at CD4 counts of 350 or below. Most guidelines in developed countries recommend starting treatment between 350 and 500, but in reality, people who have health insurance or their own money can start at any CD4 count. Sidibé says he hopes the new results will compel pharmaceutical companies to lower the price of ARVs as the demand for the drugs expands. He also anticipates that new partnerships will form to advocate for increased funding and that the findings will be prominently discussed next month at the United Nations High Level Meeting on AIDS in New York City.

　　But some HIV/AIDS advocates question whether the world will respond appropriately to this good news. Matthew Kavanagh, director of U.S. advocacy for Health GAP (Global Access Project) in Washington, D.C., notes that the U.S. government’s PEPFAR program—which supplies about half the ARVs to people in developing countries—has no plans to scale up. “It’s crazy to me that we’re hearing out of PEPFAR and other places there is not a strategy to roll this out,” Kavanagh says. “The U.S. could be stepping up and saying, 'We have an amazing finding and let’s galvanize the world around this.' ”
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　　Kavanagh notes that the Global Fund to Fight AIDS, Tuberculosis and Malaria—which provides the other half of HIV treatment for the poor countries—also has far less money than it needs. “If there’s not a renewed emphasis that, at all costs, we have to scale up treatment for both life-saving and prevention benefits, we’re going to see a reversal of fortunes and we’ re not going to be able to make use of what the science is telling us,” he says.

　　原文链接：http://news.sciencemag.org/scien ... monkeys.html?ref=hp

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