《柳葉刀》（The Lancet）網(wǎng)站于2010年5月27日發(fā)布的科學(xué)抗病文章“抗病毒藥物治療后HIV－1異性傳播的前瞻性隊(duì)列研究”發(fā)現(xiàn)：進(jìn)行抗病毒治療的艾滋病患者，其將病毒傳播給性伴侶的研究異性研究幾率明顯低于沒有進(jìn)行抗病毒治療的患者；同時(shí)發(fā)現(xiàn)，在未進(jìn)行抗病毒藥物治療的毒藥的前隊(duì)列患者中，CD4淋巴細(xì)胞計(jì)數(shù)低于200/μL的物治傳播率高，而CD4淋巴細(xì)胞計(jì)數(shù)高于200/μL 但病毒載量超過50 000 copies / mL 者其傳播率高達(dá)70％。療后CD4淋巴細(xì)胞計(jì)數(shù)和病毒載量是傳播兩個(gè)重要的治療指標(biāo)，由此可見，瞻性提供規(guī)范的科學(xué)抗病抗病毒藥物治療可以降低艾滋病病毒的傳播率。

以下為該文的研究異性研究原文摘要。毒藥的前隊(duì)列

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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 0·37 (95% CI 0·09—2·04) per 100 person-years in those who had initiated treatment and 2·24 (1·84—2·72) per 100 person-years in those who had not—a 92% reduction (adjusted incidence rate ratio 0·08, 95% CI 0·00—0·57, p=0·004). In participants not on ART, the highest HIV-1 transmission rate (8·79 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.

（編輯：李澤榮）