艾滋病抗病毒治疗救命药不可停：抗病毒治疗停药对HIV感染者存活及二代传播的影响
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">为进一步<span style="color: black;">加强</span></span><span style="color: black;">HIV</span><span style="color: black;">感染者<span style="color: black;">存活</span>及降低二代传播<span style="color: black;">危害</span>，我国<span style="color: black;">经过</span>扩大检测积极推行全员</span><span style="color: black;">HIV</span><span style="color: black;">抗病毒治疗策略，即<span style="color: black;">初期</span>治疗和<span style="color: black;">即时</span>治疗艾滋病防治策略。<span style="color: black;">然则</span>，抗病毒治疗停药对</span><span style="color: black;">HIV</span><span style="color: black;">感染者<span style="color: black;">存活</span>及二代传播有着很大的影响<span style="color: black;">功效</span>。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">抗病毒治疗停药影响HIV感染者<span style="color: black;">存活</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">保持</span>抗病毒治疗的</span><span style="color: black;">HIV</span><span style="color: black;">感染人群，在治疗后</span><span style="color: black;">10</span><span style="color: black;">年的<span style="color: black;">存活</span>率超过</span><span style="color: black;">87.5%</span><span style="color: black;">，停药的</span><span style="color: black;">HIV</span><span style="color: black;">感染者</span><span style="color: black;">9</span><span style="color: black;">年的<span style="color: black;">存活</span>率仅仅在</span><span style="color: black;">50.0%</span><span style="color: black;">，而未治疗的</span><span style="color: black;">HIV</span><span style="color: black;">感染者</span><span style="color: black;">2</span><span style="color: black;">年的<span style="color: black;">存活</span>率不到</span><span style="color: black;">50.0%</span><span style="color: black;">。<span style="color: black;">因此呢</span>，进一步降低停药和<span style="color: black;">加强</span>治疗比例是<span style="color: black;">加强</span></span><span style="color: black;">HIV</span><span style="color: black;">感染者<span style="color: black;">存活</span>的<span style="color: black;">重要</span>性<span style="color: black;">办法</span>。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="//q6.itc.cn/q_70/images03/20240529/cc2da36228f54bacb0cbe82bd667628d.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">抗病毒治疗停药影响HIV二代传播</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">HIV</span><span style="color: black;">分子网络<span style="color: black;">科研</span>结果<span style="color: black;">表示</span></span><span style="color: black;"></span><span style="color: black;">，抗病毒治疗且病毒载量</span><span style="color: black;"><50 copies/mL</span><span style="color: black;">降低</span><span style="color: black;">HIV</span><span style="color: black;">二代传播<span style="color: black;">危害</span></span><span style="color: black;">36.0%-61.6%</span><span style="color: black;">，<span style="color: black;">连续</span>抗病毒治疗</span><span style="color: black;">3</span><span style="color: black;">年以上且病毒载量</span><span style="color: black;"><50 copies/mL</span><span style="color: black;">降低</span><span style="color: black;">HIV</span><span style="color: black;">二代传播<span style="color: black;">危害</span></span><span style="color: black;">65.0%-71.0%</span><span style="color: black;">。<span style="color: black;">然则</span>，未治疗、停药、在治且病毒载量未检测者的</span><span style="color: black;">HIV</span><span style="color: black;">二代传播<span style="color: black;">危害</span><span style="color: black;">没</span><span style="color: black;">明显</span>性差异。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">数学模型<span style="color: black;">评定</span>广西</span><span style="color: black;">2010<span style="color: black;">-</span>2020</span><span style="color: black;">年实施</span><span style="color: black;">GACP</span><span style="color: black;">（广西艾滋病攻坚工程项目）的效果，到</span><span style="color: black;">2020</span><span style="color: black;">年新发感染将减少</span><span style="color: black;">52.0%</span><span style="color: black;">，其中<span style="color: black;">连续</span>抗病毒治疗减少新发感染的占比达</span><span style="color: black;">71.5%</span><span style="color: black;">。中国疾控中心艾防中心联合西安交通大学和广西疾控中心<span style="color: black;">研究</span>团队</span><span style="color: black;"></span><span style="color: black;">，结合广西</span><span style="color: black;">2008-2018</span><span style="color: black;">年每年</span><span style="color: black;">HIV</span><span style="color: black;">新诊断与新治疗病例的</span><span style="color: black;">CD4</span><span style="color: black;">、死亡、停药、耐药、人口等多维数据，构建<span style="color: black;">包含</span></span><span style="color: black;">HIV</span><span style="color: black;">新发感染及耐药的</span><span style="color: black;">HIV</span><span style="color: black;">传播动力学数学模型，<span style="color: black;">评定</span>在<span style="color: black;">加强</span>抗病毒治疗比例时停药、依从性对</span><span style="color: black;">HIV</span><span style="color: black;">传播流行的影响。<span style="color: black;">科研</span>结果<span style="color: black;">显示</span>，<span style="color: black;">加强</span>抗病毒治疗覆盖率有助于减少</span><span style="color: black;">HIV</span><span style="color: black;">新发感染及<span style="color: black;">关联</span>死亡人数，但停药会<span style="color: black;">导致</span>较高的</span><span style="color: black;">HIV</span><span style="color: black;">新发感染和耐药<span style="color: black;">出现</span>，减少停药和<span style="color: black;">加强</span>服药依从性可有效减少</span><span style="color: black;">HIV</span><span style="color: black;">二代传播和耐药<span style="color: black;">出现</span>及传播。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">抗病毒治疗停药<span style="color: black;">状况</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">停药是影响抗病毒治疗效果的<span style="color: black;">要紧</span><span style="color: black;">原因</span>之一。我国西南地区</span><span style="color: black;">2010</span><span style="color: black;">-</span><span style="color: black;">2018</span><span style="color: black;">年</span><span style="color: black;"></span><span style="color: black;">、<span style="color: black;">重庆</span></span><span style="color: black;">2013</span><span style="color: black;">-</span><span style="color: black;">2017</span><span style="color: black;">年</span><span style="color: black;"></span><span style="color: black;">和广东广州</span><span style="color: black;">2016-2019</span><span style="color: black;">年</span><span style="color: black;">HIV</span><span style="color: black;">感染者的抗病毒治疗停药率分别为</span><span style="color: black;">5.52/100</span><span style="color: black;">人年、</span><span style="color: black;">4.6/100</span><span style="color: black;">人年和</span><span style="color: black;">5.99/100</span><span style="color: black;">人年</span><span style="color: black;">。其中，<span style="color: black;">抗病毒治疗第</span></span><span style="color: black;">1</span><span style="color: black;">年的停药率最高</span><span style="color: black;"></span><span style="color: black;">。</span><span style="color: black;">基线</span><span style="color: black;">CD4</span><span style="color: black;">计数</span><span style="color: black;">>500 cell/μL</span><span style="color: black;">（</span><span style="color: black;">AHR</span><span style="color: black;">= 1.17</span><span style="color: black;">）的</span><span style="color: black;">HIV</span><span style="color: black;">感染者停药率高</span><span style="color: black;"></span><span style="color: black;">，延迟抗病毒治疗的停药<span style="color: black;">危害</span><span style="color: black;">增多</span>（</span><span style="color: black;">31-90</span><span style="color: black;">天：</span><span style="color: black;">AHR</span><span style="color: black;">=1.3</span><span style="color: black;">，</span><span style="color: black;">91-365</span><span style="color: black;">天：</span><span style="color: black;">AHR</span><span style="color: black;">=1.9</span><span style="color: black;">，</span><span style="color: black;">> 365</span><span style="color: black;">天：</span><span style="color: black;">AHR</span><span style="color: black;">=2.2</span><span style="color: black;">）</span><span style="color: black;"></span><span style="color: black;">。这些<span style="color: black;">科研</span>结果说明，<span style="color: black;">初期</span>治疗的停药<span style="color: black;">危害</span>高，但<span style="color: black;">即时</span>治疗可有助于减少停药。并且，<span style="color: black;">初期</span>治疗和<span style="color: black;">即时</span>治疗均有助于减少治疗后病毒<span style="color: black;">控制</span>失败<span style="color: black;">。</span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">抗病毒治疗停药者耐药<span style="color: black;">状况</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">我国部分省份</span><span style="color: black;">HIV</span><span style="color: black;">感染者停药</span><span style="color: black;">1</span><span style="color: black;">个月后耐药率</span><span style="color: black;">19.3%</span><span style="color: black;">，停药</span><span style="color: black;">24</span><span style="color: black;">个月后病毒载量</span><span style="color: black;">≥1000 copies/mL</span><span style="color: black;">比例为</span><span style="color: black;">93.1%</span><span style="color: black;">。分子网络<span style="color: black;">科研</span>结果<span style="color: black;">表示</span>，停药、病毒<span style="color: black;">控制</span>失败的</span><span style="color: black;">HIV</span><span style="color: black;">感染者<span style="color: black;">拥有</span>更高二代传播<span style="color: black;">危害</span></span><span style="color: black;"></span><span style="color: black;">。我国未治疗</span><span style="color: black;">HIV</span><span style="color: black;">感染者耐药率趋势性分析结果<span style="color: black;">表示</span>，耐药率从</span><span style="color: black;">2004<span style="color: black;">-</span>2007</span><span style="color: black;">年</span><span style="color: black;">2.6%</span><span style="color: black;"><span style="color: black;">提升</span>到</span><span style="color: black;">2020<span style="color: black;">-</span>2022</span><span style="color: black;">年</span><span style="color: black;">7.8%</span><span style="color: black;">。耐药与抗病毒治疗病毒<span style="color: black;">控制</span>失败及死亡<span style="color: black;">危害</span>有<span style="color: black;">明显</span>性关系</span><span style="color: black;">。这些<span style="color: black;">科研</span>结果说明，耐药严重影响到艾滋病防治工作成效，耐药高流行<span style="color: black;">乃至</span>可能<span style="color: black;">引起</span>“<span style="color: black;">没</span>药可医”。<span style="color: black;">因此呢</span>，急需<span style="color: black;">经过</span>减少停药并<span style="color: black;">加强</span>治疗后病毒<span style="color: black;">控制</span>及降低耐药水平以预防<span style="color: black;">掌控</span></span><span style="color: black;">HIV</span><span style="color: black;">二代传播及耐药<span style="color: black;">出现</span>流行。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">今后在扩大检测和治疗的<span style="color: black;">基本</span>上，有必要把工作重点放在抗病毒治疗的服务管理上，以减少停药和<span style="color: black;">加强</span>服药依从性，<span style="color: black;">加强</span>治疗后病毒载量检测及病毒<span style="color: black;">控制</span>水平，这些与<span style="color: black;">初期</span>治疗和<span style="color: black;">即时</span>治疗<span style="color: black;">一样</span><span style="color: black;">要紧</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">（中国疾控艾防中心 阮玉华）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">参考文献：</span></p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"></span><span style="color: black;">Chen Y, Cao Z, Li J, et al. HIV transmission and associated factors under the scale-up of HIV antiretroviral therapy: a population-based longitudinal molecular network study . Virology Journal, 2023, 20(1).</span></p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> Chen H, Hu J, Song C, et al. Molecular transmission network of pretreatment drug resistance among human immunodeficiency virus-positive individuals and the impact of virological failure on those who received antiretroviral therapy in China. Front Med (Lausanne). 2022 Aug 29;9:965836. doi: 10.3389/fmed.2022.965836.</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"> Zhang T, Liao L, Shao Y, Feng Y, Ruan Y, Xing H. Relationship Between Drug Resistance and Death in HIV-Infected Patients Receiving Antiretroviral Therapy -7 PLADs, China, 2010-2019. China CDC Wkly. 2021 Apr 2;3(14):291-297.</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">源自</span>：</span><span style="color: black;">中国疾控艾防中心</span></span></p>
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