专家建议重视HIV预防


  February 27, 2007 — 在第14届逆转录病毒及机会性感染研讨会(the 14th Conference on Retroviruses and Opportunistic Infections)开始之前,专家们在一场社区预防研究训练会议中,辩论各种的HIV预防策略:男性包皮环切术、治疗疱疹病毒感染、性行为前后的预防措施。
  
  【环切术有惊人的预防效果】
  临床试验结果证明男性包皮环切术是预防母子垂直传染以外的最佳HIV预防方法,这个惊人的结果是由预防专家、加州大学洛杉矶分校的Thomas J. Coates 博士所发表。
  
  他把环切术称为「最佳议题」,认为可以刺激预防介入方式的新思维,可以涵盖行为学、社会学和生物医学等面向;他表示,环切术不只是一种手术,它可以让我们在国内和国际间有机会重新思考介入预防的方式。
  
  Coates医师表示,环切术不只是开发中国家或者高感染率国家的议题,他指出美国的环切术比率在所有成年男性减少了50%,在发生新感染者之中有半数是年轻人,这些人的环切术比率更低。
  
  有许多州停止了新生儿包皮环切术的医疗保险给付,此外,非洲裔美国人比较不喜欢进行包皮环切术,这或许也是该族群HIV感染率较高的可能原因。
  
  【治疗 HSV-2 感染】
  最近发表的研究显示,治疗单纯疱疹病毒第二型 (HSV-2)可以让那些已经感染者降低生殖器散布期和减缓疾病恶化,让他们再度有预防机会。
  基于该篇研究,Coates医师建议,各种的疱疹病毒治疗药物都是非常便宜且有效的,而且相当安全、几乎没有抗药性,甚至可以考虑加在饮水中投药。
  
  他表示,这些介入方式可以破除那些导致HIV流行的不公平现象,我们可以用这些来作为和不公平战斗的机会,以确保健康照护的需求;他也将此视为再次建立以信赖为基础之社区预防议题的最佳窗口,他表示,重视医疗介入可以帮助超越文化藩篱。
  
  【重视预防计画、PEP】
  在国际方面,Coates医师认为可以透过「President's Emergency Plan for AIDS Relief / PEPFAR」重新聚焦在预防上面;在南非,继续服用 ARVs [抗反转录病毒药物]的人中,有 7个人罹患HIV;我们从未在流行性之前取得先机,只在变成实际情形之后去面对。
  
  在同一场讨论会中,加州大学旧金山分校的研究者、Robert Grant医师讨论到在性行为前后(PrEP 和 PEP)使用抗HIV药物作为预防介入的方法,口服预防药物可以有效地每日提醒那些有HIV风险者,让他们调整行为模式以降低风险。
  
  Grant医师表示,那些认为自己曝露在HIV风险者之有风险的行为比率降低,并且参加了旧金山和里约热内卢的PEP计画;他表示,改变危险性行为模式就像戒菸一样;有些人可以不需要任何帮助、一次就成功,有些人则要失败多次才成功。
  
  Coates医师鼓励从世界卫生组织创办的推广开发中国家HIV治疗的「"3 x 5"运动」中获得相关经验,该运动有极大的目标但是未达预期,不过不失为一个明确的、易懂的目标,可以有力的抓住人们的注意力,并促使他们展开行动。
  
  他呼吁国内外的相关单位想出一些类似的简单易懂的方法,让这些成为预防教育的基础。
  
  14届CROI: CHAMP 学院:HIV 预防之研究提议 — AIDS 专家的技术与挑战。发表于2007年2月25日。

Experts Advise Focus on HIV Pr

By
Medscape Medical News

February 27, 2007 — Various HIV prevention strategies, including male circumcision, treatment of herpes coinfection, and pre- and postexposure prophylaxis, were debated by experts at a training session for community advocates for prevention research prior to the start of the 14th Conference on Retroviruses and Opportunistic Infections.

Circumcision "Fantastic" for Prevention

The results from clinical trials of "male circumcision is the best thing that has happened in HIV prevention since the prevention of mother-to-child transmission. This is a fantastic result," said prevention expert Thomas J. Coates, PhD, now a professor in residence at the University of California at Los Angeles.

He called circumcision "the perfect issue" to stimulate new thinking on prevention interventions that combine behavioral, social, and biomedical approaches.

"Circumcision is not just a surgical procedure," he explained. "So it gives us the opportunity, I think, to rejuvenate the entirety of prevention," both domestically and internationally.

Dr. Coates said circumcision is not just an issue for the developing world or for countries with high prevalence of infection. He pointed out that the rate of circumcision in the United States has declined to about 50% of all adult men, and it is lowest among the younger age groups in which half of new infections occur.

Several states have dropped Medicaid coverage of circumcision of newborns. In addition, African Americans are less likely to be circumcised, which is likely a factor contributing to higher rates of HIV infection within that population.

Treatment of HSV-2 Coinfection

The recently published study showing that treating herpes simplex virus type 2 (HSV-2) can reduce genital shedding and disease progression for those already infected is another opportunity to revitalize prevention. It led Dr. Coates to suggest "universal access to herpes suppressing medications, which are very cheap, very effective, have an incredibly safe profile, and resistance doesn't develop. We should be putting it in the drinking water."

While he acknowledged that neither of these interventions will do away with the inequities that drive the HIV epidemic, he said, "we can use it as an opportunity to fight inequity" in access to healthcare.

He also sees it as "a unique window to reengage faith-based communities around the whole issue of prevention." The focus upon medical interventions can help get beyond the culture clashes, he said.

Focus on Prevention Programs, PEP

Internationally, Dr. Coates called for a renewed focus on prevention through programs such as the President's Emergency Plan for AIDS Relief (PEPFAR). "For every person going on ARVs [antiretroviral drugs] in South Africa, 7 people get HIV. We are never going to get ahead of the epidemic as long as that is the case."

At the same forum, University of California at San Francisco researcher Robert Grant, MD, discussed using anti-HIV drugs as pre- and postexposure prophylaxis (PrEP and PEP) as part of prevention interventions. "It could be that an effective oral prevention [pill] could serve as a daily reminder that people are at risk for HIV," which might reinforce modification of their behavior to reduce that risk.

Dr. Grant noted that risk behavior decreased among people who thought they had been exposed to HIV and participated in PEP programs in both San Francisco and Rio de Janeiro. He said, changing patterns of risky sexual behavior can be similar to stopping smoking; some people can do it without assistance the first time, while others may try and fail a number of times before succeeding.

Dr. Coates urged the advocates to learn from the experience of the "3 x 5" campaign that the World Health Organization created to push forward implementation of broad access to HIV therapy in the developing world. It was wildly ambitious and fell short of that goal, but it was a tangible, understandable objective that had the power to capture people's imagination and move them to action.

He challenged the activists to come up with a similar easily understood program for prevention, both domestically and internationally, and make it the basis for their advocacy.

14th CROI: CHAMP Academy: Research Advocacy for HIV Prevention — Skills & Challenges for AIDS Activists. Presented February 25, 2007.

    
相关报导
WHO指引:每个HIV病患都应接受抗逆转录病毒疗法(ART)
2015/10/16 上午 10:07:50
孩童的带状疱疹比预期更常见
2015/3/3 下午 02:46:00
日益常见的性短讯与青少年性行为增加有关
2014/1/21 下午 05:18:17

上一页
   1   2   3   4   5   6   7   8   9   10  




回上一页