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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2024, Vol. 18 ›› Issue (04) : 193 -199. doi: 10.3877/cma.j.issn.1674-1358.2024.04.001

综述

人类免疫缺陷病毒感染快速启动抗逆转录病毒治疗研究及模式探索
戚仕轩, 阮连国†()   
  1. 430040 武汉市，华中科技大学同济医学院附属武汉金银潭医院感染科
  • 收稿日期:2024-04-04 出版日期:2024-08-08
  • 通信作者: 阮连国
  • 基金资助:
    湖北省卫生健康委员会项目（No. ZY2021M039）

Research progress on rapid initiation of antiretroviral therapy for human immunodeficiency virus infection and model exploration

Shixuan Qi, Lianguo Ruan†()   

  1. Department of Infectious Diseases, Jinyintan Hospital, Huazhong University of Scientific and Technology, Wuhan 430040, China
  • Received:2024-04-04 Published:2024-08-08
  • Corresponding author: Lianguo Ruan
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戚仕轩, 阮连国. 人类免疫缺陷病毒感染快速启动抗逆转录病毒治疗研究及模式探索[J]. 中华实验和临床感染病杂志(电子版), 2024, 18(04): 193-199.

Shixuan Qi, Lianguo Ruan. Research progress on rapid initiation of antiretroviral therapy for human immunodeficiency virus infection and model exploration[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2024, 18(04): 193-199.

2017年世界卫生组织发出人类免疫缺陷病毒（HIV）感染者“发现即治疗”的倡议，2023年我国在诸多国际指南的基础上颁布了《快速启动艾滋病抗病毒治疗专家共识》，建议所有HIV感染者于确诊7日内启动抗逆转录病毒治疗（ART），甚至在确诊当天即启动ART。该模式可提高治疗覆盖率和治疗队列保持率、ART成功率以及降低病死率等。我国已采取了多种措施以推动快速启动ART模式，但该治疗模式的推行仍面临来自患者以及获得性免疫缺陷综合征（AIDS）治疗管理等结构因素的挑战。可通过加强医防融合，简化转介流程、探索流动人口转介治疗模式、加强医务人员快速启动ART理念和能力培训、提高实验室报告及时性和ART药物可及性等方面完善进一步的探索调整，以建立符合我国国情的可持续快速启动ART模式。本文对HIV感染者快速启动ART研究现状和启动ART模式进行综述。

关键词: 人类免疫缺陷病毒, 快速启动, 抗逆转录病毒治疗, 临床指南

The World Health Organization issued the “Treat all” initiative for human immunodeficiency virus (HIV)-positive individuals in 2017. Based on many international guidelines,an expert consensus on the rapid initiation of antiretroviral therapy (ART) in 2023 was issued in China,recommending that all HIV-positive individuals start ART within 7 days after diagnosis, or even on the same day as diagnosis. This model has benefits such as increasing treatment coverage and retention rates,improving ART success rates, and reducing mortality rates. China has implemented various measures to promote the rapid initiation of ART, but the implementation of this treatment model still faces challenges from patient-related and structural factors such as HIV treatment management. Further exploration and adjustments can be made by enhancing the integration of medical and preventive care, simplifying referral processes, exploring referral treatment models for mobile populations, strengthening training for healthcare professionals on rapid initiation concepts and capabilities, improving the timeliness of laboratory reports, and increasing the accessibility of ART medications, in order to establish a sustainable rapid start model suited to national conditions of China. This review summarizes the current research status and rapid initiation ART in individuals with HIV infection.

Key words: Human immunodeficiency virus, Rapid initiation, Antiretroviral therapy, Clinical guideline
图1 HAART历史沿革图
表1 国内外权威指南及共识关于快速启动ART 推荐
指南 推荐意见 方案
WHO 2021[7] 1）应为所有确诊HIV感染、完成临床评估的HIV感染者提供Rapid ART（定义为确诊后7d内）； DTG+TDF+（FTC或3TC）
2）应为做好准备的患者提供ART当日启动
DHHS 2023[8] 1）所有HIV感染者接受ART； BIC/FTC/TAF、DTG+（TAF或TDF）+（FTC或3TC）、bDRV+（TAF或TDF）+（FTC或3TC）
2）确诊HIV后立即（或尽快）启动ART，以改善ART启动率和诊疗衔接、缩短患者达到病毒学抑制所需时间、提高HIV感染者的病毒学抑制率
IAS-USA 2023[9] 1）确诊后尽快启动ART（理想情况下应在7d内），做好准备且不合并机会性感染的患者可在确诊当日或首次就诊时启动； ARTBIC/FTC/TAF、DTG+（TAF或TDF）+（FTC或3TC）
2）确诊为急性感染期时启动ART；
3）对于大多数机会性感染，推荐在开始治疗后2周内启动
EACS 2023[10] 1）原发性HIV感染合并出现脑膜脑炎的临床体征和症状（数小时内）； BIC/FTC/TAF、DTG+（FTC或3TC）、TAF/FTC或TDF/XTC+RAL或DTF或DOR、ABC+3TC+DTG
2）希望立即开始ART；
3）如不在同一天开始ART，患者有可能会丢失随访
中国快速启动艾滋病抗病毒治疗专家共识[11]2023 对于确诊HIV感染者，推荐诊断7d内快速启动ART；有意愿且做好准备的患者可在诊断当日启动ART BIC/FTC/TAF、DTG或bPI+（TAF或TDF）+（FTC或3TC）
[1]
Violari A, Cotton MF, Gibb DM, et al. Early antiretroviral therapy and mortality among HIV-infected infants[J]. N Engl J Med,2008,359(21):2233-2244.
[2]
Cohen MS, Chen YQ, Mccauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy[J]. N Engl J Med, 2011,365(6):493-505.
[3]
Cain LE, Logan R, Robins JM, et al. When to initiate combined antiretroviral therapy to reduce mortality and AIDS-defining illness in HIV-infected persons in developed countries: an observational study[J]. Ann Intern Med,2011,154(8):509-515.
[4]
Sterne JAC, May M, Costagliola D, et al. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients:a collaborative analysis of 18 HIV cohort studies[J]. Lancet,2009,373(9672):1352-1363.
[5]
Kitahata MM, Gange SJ, Abraham AG, et al. Effect of early versus deferred antiretroviral therapy for HIV on survival[J]. N Engl J Med,2009,360(18):1815-1826.
[6]
World Health Organization. Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy, July 2017[M].Geneva: World Health Organization,2017:56.
[7]
World Health Organization. HIV prevention, testing, treatment,service delivery and monitoring: Recommendations for a public health approach[M]. World Health Organization,2021:123
[8]
Panel on Antiretroviral Guidelines for Adults and Adolescents.Guidelines for the use of antiretroviral agents in adults and adolescents with HIV[M]. Department of Health and Human Services,2022:G-4
[9]
Gandhi RT, Bedimo R, Hoy JF, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2022 recommendations of the international antiviral society-USA panel[J].JAMA,2023,329(1):63-84.
[10]
EACS Guidelines version 12.0, October 2023[M]. European AIDS Clinical Society,2023:15
[11]
代丽丽, 陈仁芳, 陈耀凯, 等. 快速启动艾滋病抗病毒治疗专家共识[J].中国艾滋病性病,2023,29(7):737-744.
[12]
Waters L, Winston A, Reeves I, et al. BHIVA guidelines on antiretroviral treatment for adults living with HIV-1 2022[J]. HIV Med,2022,23(Suppl 5):3-115.
[13]
Pérez-Molina JA, Polo R, López-Aldeguer J, et al. Executive summary of the GeSIDA/National AIDS Plan consensus document on antiretroviral therapy in adults infected by the human immunodeficiency virus (updated January 2018)[J]. Enferm Infecc Microbiol Clin (Engl Ed),2019,37(3):195-202.
[14]
The Korean Society For AIDS. The 2018 clinical guidelines for the diagnosis and treatment of HIV/AIDS in HIV-infected Koreans[J].Infect Chemother,2019,51(1):77-88.
[15]
Choy CY, Wong CS, Kumar PA, et al. Recommendations for the use of antiretroviral therapy in adults living with human immunodeficiency virus in Singapore[J]. Singapore Med J,2024,65(5):259-273
[16]
台湾艾滋病学会. 艾滋病检验及治疗指引第六版[M]. 2020:5
[17]
Perez F, Gomez B, Ravasi G, et al. Progress and challenges in implementing HIV care and treatment policies in Latin America following the treatment 2.0 initiative[J]. BMC Public Health,2015,15:1260.
[18]
Nel J, Dlamini S, Meintjes G, et al. Southern African HIV Clinicians Society guidelines for antiretroviral therapy in adults: 2020 update[J].South Afr J HIV Med,2020,21(1):1115.
[19]
Bacon O, Chin J, Cohen SE, et al. Decreased time from human immunodeficiency virus diagnosis to care, antiretroviral therapy initiation, and virologic suppression during the citywide RAPID initiative in San Francisco[J]. Clin Infect Dis,2021,73(1):e122-e128.
[20]
Labhardt ND, Ringera I, Lejone TI, et al. Effect of offering sameday ART vs usual health facility referral during home-based HIV testing on linkage to care and viral suppression among adults with HIV in Lesotho: The CASCADE randomized clinical trial[J].JAMA,2018,319(11):1103-1112.
[21]
Black S, Zulliger R, Myer L, et al. Safety, feasibility and efficacy of a rapid ART initiation in pregnancy pilot programme in Cape Town,South Africa[J]. S Afr Med J,2013,103(8):557-562.
[22]
Danel C, Moh R, Gabillard D, et al. A Trial of early antiretrovirals and isoniazid preventive therapy in Africa[J]. N Engl J Med,2015,373(9):808-822.
[23]
Kamya MR, Petersen ML, Kabami J, et al. Search human immunodeficiency virus (HIV) streamlined treatment intervention reduces mortality at a population level in men with low CD4 counts[J]. Clin Infect Dis,2021,73(7):e1938-e1945.
[24]
Wu Z, Zhao Y, Ge X, et al. Simplified HIV testing and treatment in China: analysis of mortality rates before and after a structural intervention[J]. PLoS Med,2015,12(9):e1001874.
[25]
O’connor J, Vjecha MJ, Phillips AN, et al. Effect of immediate initiation of antiretroviral therapy on risk of severe bacterial infections in HIV-positive people with CD4 cell counts of more than 500 cells per μl: secondary outcome results from a randomised controlled trial[J]. Lancet HIV,2017,4(3):e105-e112.
[26]
Severe P, Juste MAJ, Ambroise A, et al. Early versus standard antiretroviral therapy for HIV-infected adults in Haiti[J]. N Engl J Med,2010,363(3):257-265.
[27]
曾雪灵, 杨思园, 常宇飞, 等. 176例人类免疫缺陷病毒合并肺部感染者呼吸道病原体特点与免疫学特征[J/CD]. 中华实验和临床感染病杂志(电子版),2024,18(3):142-148.
[28]
Long LC, Maskew M, Brennan AT, et al. Initiating antiretroviral therapy for HIV at a patient’s first clinic visit: a cost-effectiveness analysis of the rapid initiation of treatment randomized controlled trial[J]. AIDS,2017,31(11):1611-1619.
[29]
Laughton B, Cornell M, Grove D, et al. Early antiretroviral therapy improves neurodevelopmental outcomes in infants[J].AIDS,2012,26(13):1685-1690.
[30]
Borges ÁH, Neuhaus J, Babiker AG, et al. Immediate antiretroviral therapy reduces risk of infection-related cancer during early HIV infection[J]. Clin Infect Dis,2016,63(12):1668-1676.
[31]
Al-Hayani AWM, Cabello-Úbeda A, Del Palacio-Tamarit M, et al.Initiation of antiretroviral therapy in treatment-naive adults with HIV infection at the first specialist appointment[J]. J Antimicrob Chemother,2022,77(6):1741-1747.
[32]
Kunisaki KM, Niewoehner DE, Collins G, et al. Pulmonary effects of immediate versus deferred antiretroviral therapy in HIV-positive individuals: a nested substudy within the multicentre, international,randomised, controlled Strategic Timing of Antiretroviral Treatment(START) trial[J]. Lancet Respir Med,2016,4(12):980-989.
[33]
中华医学会感染病学分会艾滋病丙型肝炎学组, 中国疾病预防控制中心. 中国艾滋病诊疗指南(2021年版)[J]. 协和医学杂志,2022,13(2):203-226.
[34]
Zhao Y, Wu Z, Mcgoogan JM, et al. Nationwide cohort study of antiretroviral therapy timing: treatment dropout and virological failure in China, 2011-2015[J]. Clin Infect Dis,2019,68(1):43-50.
[35]
Zhao Y, Wu Z, Mcgoogan JM, et al. Immediate antiretroviral therapy decreases mortality among patients with high CD4 counts in China: A nationwide, retrospective cohort study[J]. Clin Infect Dis,2018,66(5):727-734.
[36]
Liu P, Tang Z, Lan G, et al. Early antiretroviral therapy on reducing HIV transmission in China: strengths, weaknesses and next focus of the program[J]. Sci Rep,2018,8(1):3431.
[37]
Zhou C, Zhang W, Lu RR, et al. Benefits of early and immediate initiation of antiretroviral therapy among HIV patients in Chongqing,China[J]. Biomed Environ Sci,2020,33(4):282-285.
[38]
Wu C, Zhang B, Dai Z, et al. Impact of immediate initiation of antiretroviral therapy among men who have sex with men infected with HIV in Chengdu, southwest China: trends analysis, 2008-2018[J]. BMC Public Health,2021,21(1):689.
[39]
矫洁, 代丽丽, 陈晓红. 艾滋病快速抗病毒治疗策略的研究进展[J].中国艾滋病性病,2020,26(6):660-663.
[40]
康文, 孙永涛. 中国HIV感染快速启动抗病毒治疗的获益挑战和模式探索[J]. 中国艾滋病性病,2020,26(9):1025-1029.
[41]
朱金辉, 李立明. 艾滋病病毒感染者尽早启动抗病毒治疗研究进展[J].应用预防医学,2019,25(4):344-347, 343.
[42]
Domingues CSB, Waldman EA. Causes of death among people living with AIDS in the pre- and post-HAART Eras in the city of São Paulo,Brazil[J]. PLoS One,2014,9(12):e114661.
[43]
Wang J, Wang G, Zhu X, et al. The care status and factors affecting antiretroviral therapy timing for people living with HIV: a retrospective cohort study in Shandong Province, China[J]. AIDS Care,2023;35(12):1963-1970.
[44]
赵塔娜, 曾茵茹, 李文瑞, 等. 我国HIV感染者/AIDS患者晚发现发生率及影响因素的meta分析[J]. 职业与健康,2023,39(12):1682-1685, 1690.
[45]
金霞, 熊燃, 王丽艳, 等. 2010-2014年我国HIV感染病例的晚发现情况分析[J]. 中华流行病学杂志,2016,37(2):218-221.
[46]
Mocroft A, Lundgren JD, Sabin ML, et al. Risk factors and outcomes for late presentation for HIV-positive persons in Europe: results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)[J]. PLoS Med,2013,10(9):e1001510.
[47]
Govere SM, Kalinda C, Chimbari MJ. Factors influencing rapid antiretroviral therapy initiation at four eThekwini Clinics, KwaZulu-Natal, South Africa[J]. AIDS Behav,2022,26(6):1821-1828.
[48]
Rosen S, Maskew M, Fox MP, et al. Initiating Antiretroviral therapy for HIV at a patient’s first clinic visit: The RapIT randomized controlled trial[J]. PLoS Med,2016,13(5):e1002015.
[49]
Larson BA, Brennan A, Mcnamara L, et al. Lost opportunities to complete CD4+ lymphocyte testing among patients who tested positive for HIV in South Africa[J]. Bull World Health Organ,2010,88(9):675-680.
[50]
Li L, Wu Z, Wu S, et al. Impacts of HIV/AIDS stigma on family identity and interactions in China[J]. Fam Syst Health,2008,26(4):431-442.
[51]
Chen WT, Shiu CS, Simoni JM, et al. In sickness and in health: a qualitative study of how Chinese women with HIV navigate stigma and negotiate disclosure within their marriages/partnerships[J]. AIDS Care,2011,23(Suppl 1):120-125.
[52]
Chen WT, Shiu C, Zhang L, et al. Care engagement with healthcare providers and symptom management self-efficacy in women living with HIV in China: secondary analysis of an intervention study[J].BMC Public Health,2022,22(1):1195.
[53]
Katirayi L, Namadingo H, Phiri M, et al. HIV-positive pregnant and postpartum women’s perspectives about Option B+ in Malawi: a qualitative study[J]. J Int AIDS Soc,2016,19(1):20919.
[54]
Black S, Zulliger R, Marcus R, et al. Acceptability and challenges of rapid ART initiation among pregnant women in a pilot programme,Cape Town, South Africa[J]. AIDS Care,2014,26(6):736-741.
[55]
Molina JM, Grund B, Gordin F, et al. Which HIV-infected adults with high CD4 T-cell counts benefit most from immediate initiation of antiretroviral therapy? A post-hoc subgroup analysis of the START trial[J]. Lancet HIV,2018,5(4):e172-e180.
[56]
Tang Z, Pan SW, Ruan Y, et al. Effects of high CD4 cell counts on death and attrition among HIV patients receiving antiretroviral treatment: an observational cohort study[J]. Sci Rep,2017,7(1):3129.
[57]
Nachega JB, Uthman OA, Del Rio C, et al. Addressing the Achilles’heel in the HIV care continuum for the success of a test-andtreat strategy to achieve an AIDS-free generation[J]. Clin Infect Dis,2014,59(Suppl 1):S21-S27.
[58]
Ren L, Li J, Zhou S, et al. Prognosis of HIV patients receiving antiretroviral therapy according to CD4 counts: A long-term followup study in Yunnan, China[J]. Sci Rep,2017,7(1):9595.
[59]
吕婉婷, 赵燕, 殷文婷, 等. 我国2016-2020年新报告HIV感染者跨省流动情况对启动抗病毒治疗的影响分析[J]. 中国艾滋病性病,2023,29(04):388-391.
[60]
国务院艾滋病防治工作委员会办公室. 第四轮全国艾滋病综合防治示范区工作指导方案[Z]. 2019.
[61]
中华医学会感染病学分会艾滋病学组,中国疾病预防控制中心. 中国艾滋病诊疗指南(2024版)[J]. 中华传染病杂志,2024,42(5):257-284.
[62]
中国疾病预防控制中心. 全国艾滋病检测技术规范(2020年修订版)[Z]. 2020.
[63]
中国疾病预防控制中心. 艾滋病病毒感染者及艾滋病患者CD4+ T淋巴细胞检测及质量保证指南[Z]. 2013.
[64]
中国疾病预防控制中心. HIV-1病毒载量检测及质量保证指南[Z].2013.
[65]
中国疾病预防控制中心. HIV-1基因型耐药检测及质量保证指南[Z].2013.
[66]
赵燕, 甘秀敏, 赵德才, 等. 我国艾滋病抗病毒治疗进展及推进高质量发展的思考[J]. 中国艾滋病性病,2023,29(6):619-622.
[67]
孙忠杏, 杨鹏伟, 杨竹梅, 等. 2018-2022年大理市新报告HIV/AIDS病例抗病毒治疗及时性及影响因素分析[J]. 预防医学情报杂志,2024. [publishe online ahead of print].
[68]
李菊梅, 高鑫, 马瑞, 等. 2022年四川省新报告HIV感染者抗病毒治疗及时性及影响因素分析[J]. 预防医学情报杂志,2024. [publishe online ahead of print].
[69]
金琳, 刘爱文, 张进, 等. 安徽省2017-2022年新报告HIV/AIDS患者抗病毒治疗及时性影响因素分析[J]. 中国艾滋病性病,2024,30(5):466-470.
[70]
宋晓甜, 黄璐, 安竹, 等. 强化宣传教育对贵州部分地区HIV/AIDS病人抗病毒治疗及时性及随访状态的影响[J]. 中国艾滋病性病,2018,24(8):824-827.
[71]
谢年华, 闫晗, 马红飞, 等. 武汉市医防协同提高艾滋病抗病毒治疗及时性模式探索与实践[J]. 中国艾滋病性病,2024,30(2):183-185.
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