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- 李侗曾副主任医师
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医院:
首都医科大学附属北京佑安医院
科室:
综合感染科
- Q 热(羊流感)
- 狂犬病暴露后预防
- 霍乱诊疗常规
- 麻疹
- 眼泪或为艾滋病传播新途径 专家...
- 又一项艾滋病疫苗研制计划受阻
- 李兰娟:《柳叶刀》人感染禽源性...
- 《人类感染活禽市场来源的新发H...
- 第二例被治愈的艾滋病感染者
- 霍乱诊疗常规
- 布氏杆菌病诊疗常规
- 手足口2012
- 艾滋病实名检测之我见
- 艾滋病---抗病毒治疗可以减少...
- 关于柳叶刀一篇HIV-N亚型个...
- 艾滋病合并结核时---尽快抗病...
- CD4细胞计数的意义?
- 共享性伴侣是导致 HIV 发生...
- HIV药物导致未老先衰
- 为什么有半年甚至一年窗口期的说...
- 医生的严谨和随意
- 初筛阳性,确证阴性
- 未知病毒之我见
- HCV诊治指南
- 艾滋病HAART治疗免疫重建炎...
- 欧洲肝脏研究学会《丙型肝炎诊疗...
- 尽早开始抗逆转录病毒治疗可以减...
- 恐艾者分型分期,你是哪型哪期?
- 关于HIV检测
- 关于抗体阴性感染者文献
- 博茨瓦纳一例抗体阴性的HIV-...
- 观看电影《盗梦空间》后的感想,...
- 中国医生面临威胁(Lancet...
- CD4达到100以上就可以停用...
- 手足口病最严重的情况
- 转卫生部手足口知识问答
- 麻疹(五)宝宝8个月时接种麻疹...
- 麻疹(四)今年麻疹为什么这么多
- Q热(羊流感)临床表现多样
- Q 热(羊流感)
- 关于原发性胆汁性肝硬化
- 我院年龄最小的呼吸机支持患儿顺...
- 特殊人群如何降低自己在甲型H1...
- 甲型H1N1流感感染者任何年龄...
- 甲型H1N1流感诊疗方案(第三...
- 转帖:关于HIV-1 O/N的...
- 关于HIV的O,N ,M亚群检...
- 美国研究者称艾滋病有望被治愈
- 全球艾滋病防控已经取得重大进步
- 新英格兰医学杂志论文:人类出现...
- 美国感染A/H1N1流感可能已...
- 合并其它疾病可能是猪流感致死的...
- 什么是猪流感(Swine fl...
- HIV感染者开始抗病毒治疗的时...
- HIV毒性正在增加?
- 艾滋病将要被治愈?
- 作者:李侗曾|发布时间:2012-08-28|浏览量:15419次
全球最权威的医学杂志新英格兰杂志2012年8月23日发表的
开始终结艾滋病?
因为一些口服抗病毒药物的成功以及艾滋病疫苗获得了阶段性胜利,人们开始对消灭艾滋病产生乐观的展望,而且出现了第一例艾滋病治愈病例,现有的抗病毒治疗不仅仅对感染者有益,而且可以使得性传播艾滋病减少96%,基于上述原因,我们有理由,实现控制艾滋病的时代也许不远了。
美国国务卿克林顿.希拉里的口号“我们想要的是什么?---无艾滋病时代!”通过不断扩大的高质量的预防和治疗措施,实现感染者健康生成和新感染者持续减少。艾滋病疫苗是其中的关键,RV144是在泰国的成年人中显示了一定的保护作用。
The Beginning of the End of AIDS?
We are at a moment of extraordinary optimism in the response to the human immunodeficiency virus (HIV). A series of scientific breakthroughs, including several trials showing the partial efficacy of oral and topical chemoprophylaxis1,2 and the first evidence of efficacy for an HIV vaccine candidate,3 have the potential to markedly expand the available preventive tools. There is evidence of the first cure of an HIV-infected person. And most important, the finding that early initiation of antiretroviral therapy can both improve individual patient outcomes and reduce the risk of HIV transmission to sexual partners by 96%4 has led many to assert what had so long seemed impossible: that control of the HIV pandemic may be achievable.
What will it take to achieve what U.S. Secretary of State Hillary Rodham Clinton called, in a 2011 address, an “AIDS-free generation”? Expanded access to and coverage of high-quality prevention and treatment services tailored to affected populations are critical to keeping people living with HIV healthy and to dramatically reducing the number of new HIV infections.5 This goal requires an ambitious implementation-science agenda that improves efficiency and effectiveness and incorporates strategies for overcoming the stigma and discrimination that continue to limit the uptake and utilization of services. Research efforts on HIV vaccines will also probably be key, and the field has been reinvigorated, after a series of unsuccessful trials, by the findings of the RV144 trial involving Thai adults, which showed that the vaccine provided modest protection against HIV acquisition in selected populations.3 Research focused on curing HIV disease is yielding fascinating insights into how HIV persists in the face of current therapy, and such research must be earnestly pursued. A combination approach to prevention that includes HIV treatment can generate tremendous gains in the short term by curtailing new HIV infections, but ending the AIDSepidemic will probably require a vaccine, a cure, or both.
The scientific opportunities and optimism at this moment in HIV research are not matched, however, by the available resources. Global resources have been declining, not growing, in this period of scientific success. This lack of funding is the major point of divergence between optimism and pessimism. Thanks to the President's Emergency Plan for AIDSRelief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and many other donors, HIV treatment has become a reality for more than 6 million adults and children in developing countries. Yet in 2012, less than half of the people living with HIV who need treatment are receiving therapy (see Estimated Proportion of Persons with HIV Infection Receiving Antiretroviral Therapy in Low-Income Countries as of December 2010.), and realizing the prevention benefits of earlier initiation of treatment will require that millions more people receive therapy in the coming years. The cancellation of the Global Fund's 11th round of funding was the largest of several recent setbacks in the resource base forAIDSglobally.
The global fiscal realities are compounded by what we would argue are artificial debates that pitAIDSagainst other global health needs. We believe that the yield on investment in HIV research and care is unparalleled in modern medicine. Moreover, secondary benefits of AIDScare include reductions in tuberculosis rates and maternal and child mortality, expansion of health center capacity, and increases in rates of school retention and workforce participation that support overall community health. Comprehensive economic models predict that making the needed investments in HIV-related efforts will result in cost savings over the long term. It would be an extraordinary failure of global will and conscience if financial constraints and false dichotomies truncated our ability to begin to end AIDSjust when the science is showing that this goal is achievable.
The call to begin ending AIDSnecessitates consideration of the HIV epidemic here in the United States. The most sobering HIV news from the United States in 2011 was the report that in only an estimated 28% of people living with HIV in the United States has suppression of HIV RNA been achieved; such suppression is a marker of treatment success and a gauge of the risk of transmission. This deficiency exposes a challenge shared by many countries affected by HIV. The “care cascade” — entailing HIV diagnosis and linkage to and retention in or reengagement in care — is broken in the United States and in too many other countries. It is in urgent need of repair. In our zeal for prevention, we must not abandon the commitment to pioneering new approaches to treatment. These must address aging populations and those with hepatitis C, for whom revolutionary treatments are on the horizon. Every country, including ours, must develop more effective ways to reach key affected populations and to apply the tools that we know work, if we are to make significant advances.
Is there a roadmap to an AIDS-free generation? The core elements of a strategy are arguably now in hand: first, the strategic use of existing resources, including resources for accelerated research on prevention, HIV vaccines, and a cure; second, marked increases in HIV testing, counseling, and linkages to and retention in services and care; third, the eradication of mother-to-child transmission of HIV and preservation of maternal health, a goal very much within the realm of possibility with existing knowledge; and finally, expanded access to prevention services and antiretroviral treatment to reach everyone in need — which will require an end to the stigma, discrimination, legal sanctions, and human rights abuses against people at risk for or living with HIV infection. Markedly expanding high-quality treatment programs, taking new prevention tools to scale, and maximizing the potential of antiretroviral therapies for prevention will be difficult and costly, but failure to capitalize on the scientific advances of this critical period could be devastating. A future of ongoing transmission of HIV, ever-increasing numbers of people receiving or needing therapy, and further strains on overburdened health systems will not be sustainable.
As the international HIV community gathers in Washington, D.C., for the 19th InternationalAIDSConference, the meeting's theme, “Turning the Tide Together,” captures the essence of this defining moment. The response to HIV, perhaps better than efforts against any other epidemic, encapsulates what can be accomplished when scientists, policymakers, the private sector, and the community mobilize toward a common goal. Propelling us to the point where we can talk about the end of AIDSis nothing short of remarkable. Yet the most important part of the story is about to be written.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
This article was published on July 18, 2012, at NEJM.org
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