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浙江大学学报（医学版）
浙江大学学报（医学版）  2016, Vol. 45 Issue (3): 221-227    DOI: 10.3785/j.issn.1008-9292.2016.05.01
艾滋病专题     
人类免疫缺陷病毒暴露前预防的应用与挑战
沈银忠1, 卢洪洲1,2
1. 上海市公共卫生临床中心感染一科, 上海 201508;
2. 复旦大学附属华山医院感染病科, 上海 200040
Pre-exposure prophylaxis for HIV: clinical practice and challenge
SHEN Yinzhong1, LU Hongzhou1,2
1. Department of Infectious Diseases, Shanghai Public Health Clinical Center, Shanghai 201508, China;
2. Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China
全文: PDF(980 KB)  
摘要: 

抗病毒治疗不仅将HIV感染从一个致死性疾病转变为一种可以治疗的慢性疾病，同时减少了HIV在人群间的传播，近年来“治疗即是预防”的观念已被人们所认可。随着研究的深入，人们发现HIV暴露前预防（PrEP）能有效减少HIV在高危人群间的传播。临床试验显示PrEP是安全的，可以有效预防HIV感染。目前，欧美国家及WHO指南均推荐对男男性行为者、感染HIV高风险的异性性行为者、HIV单阳伴侣中的HIV阴性者以及静脉吸毒者等高危人群进行PrEP。推荐使用的药物和方法是每日口服替诺福韦和恩曲他滨合剂，部分人群也可使用替诺福韦。PrEP应结合其他预防措施如安全套使用、静脉吸毒的处理以及抗病毒治疗来进一步降低HIV感染的风险。目前，PrEP面临的主要挑战是伦理学、药物可及性、服药依从性以及使用率等问题，应该针对高危人群大力推行PrEP，让更多的人群受益减少HIV感染。
关键词 ： 获得性免疫缺陷综合征/预防和控制,  氟胞嘧啶/治疗应用,  氟胞嘧啶/类似物和衍生物,  腺嘌呤/治疗应用,  腺嘌呤/类似物和衍生物,  抗病毒药/治疗应用,  综述    
Abstract：

Antiretroviral therapy (ART) can not only turn HIV infection from a fatal disease into a treatable chronic disease, but also reduce HIV transmission among high-risk people. In recent years the concept "treatment as prevention" has been accepted by the public. More and more studies have shown that pre-exposure prophylaxis (PrEP) for HIV can effectively reduce the spreading of HIV in high-risk populations. Clinical trials have also shown that PrEP is safe, and can effectively prevent high-risk people from HIV infection. The guidelines of Europe, the United States and the World Health Organization (WHO) recommend that PrEP should be considered for high-risk populations including men who have sex with men (MSM), heterosexually active men and women, HIV-uninfected partner in serodiscordant couples and injection drug users(IDUs). PrEP with daily oral tenofovir/emtricitabine combination is the recommended PrEP regimen, and TDF alone can be considered as an alternative regimen for IDUs and heterosexually active adults. PrEP can provide a high level of protection against HIV, and is even more effective when it is combined with condoms, ART and other prevention methods. PrEP is currently facing great challenges including ethical issues, drugs accessibility, adherence, and low utilization rate, and should be further recommended for high-risk people to reduced HIV infection.
Key words： Acquired immunodeficiency syndrome/prevention &    control    Flucytosine/therapeutic use    Flucytosine/analogs &    derivatives    Adenine/therapeutic use    Adenine/analogs &    derivatives    Antiviral agents/therapeutic use    Review
收稿日期: 2016-01-03
CLC:  R512.91  
基金资助:

“十二五”国家科技重大专项（2012ZX10001-003）；国家高技术研究发展计划（863计划）（2014AA021403）
通讯作者: 卢洪洲(1966-),男,博士,教授,主任医师,博士生导师,主要从事艾滋病基础和临床研究;E-mail:luhongzhou@fudan.edu.cn;http://orcid.org/0000-0002-8308-5534     E-mail: luhongzhou@fudan.edu.cn
作者简介: 沈银忠(1974-),男,博士,副主任医师,主要从事感染性疾病基础和临床研究;E-mail:shenyinzhong@shaphc.org;http://orcid.org/0000-0002-7604-5139
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引用本文:

沈银忠 等. 人类免疫缺陷病毒暴露前预防的应用与挑战[J]. 浙江大学学报（医学版）, 2016, 45(3): 221-227.
SHEN Yinzhong, LU Hongzhou. Pre-exposure prophylaxis for HIV: clinical practice and challenge. Journal of ZheJiang University(Medical Science), 2016, 45(3): 221-227.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2016.05.01      或      http://www.zjujournals.com/xueshu/med/CN/Y2016/V45/I3/221

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