必威体育精装版hiv感染的预防ppt课件.pptVIP

随访及监测 每6个月： 监测eCrCl 患有其它疾病（如：高血压，糖尿病）的患者，还应监测肾功能、尿蛋白等 如果血肌酐升高，但eCrCl remains ≥60 ml/min，不需要特殊处理 如果eCrCl 持续降低(但仍≥60 ml/min), 需要咨询肾内科医生 每12个月：评价继续进行PrEP的必要性 Test and treat 基于HPTN 052 ：低VLs 比高VLs的人群更不易传播；有效的ART可以降低传播几率96% HPTN 052 and HPTN 071 (POPART)：检测所有的性活跃人群，治疗所有的阳性人群 疫苗？ 体液免疫 CMI：cell mediated immunity，治疗性疫苗，安全性和有效性还没有得到验证 第一个疫苗验证：泰国，有效率31% 挑战：疫苗宿主免疫抗体浓度 谢谢！ HIV感染的预防 4个环节 行为学 (如：正确的避孕套的应用，更少的性伴)，生物学 (如：包皮环切术） 性交前和性交过程干预：疫苗，暴露前的药物应用(ARV PrEP） 暴露后疫苗的应用及暴露后药物预防 (ARV PEP） 治疗即预防：对感染者有效的抗病毒治疗可以降低他们传播给同伴的风险 HIV 的传播 HIV的感染性依赖于HIV+者体液（血液、生殖器分泌物或精子）的病毒和病毒本身的 (遗传表型)： 体液中的高病毒载量有较高的感染风险 病毒亚型影响HIV的获得风险：如 clade C 比B更有感染性 Test and treatModels Many models of the effect(s) of HIV therapy on the spread of disease have been generated, with very mixed predictions (Table 3).? Researchers at the WHO offered optimistic models that helped stimulate a stronger belief that treatment will serve as prevention (see figure 6, next page). Based on some ecological studies (from Canada and the USA), investigators have argued that a falling number of patients with newly diagnosed HIV in recent years reflects the effects of ART in the community. In addition, further evidence for the population level benefit of ART has come from the AFRICA CENTRE in Kawazu Natal. Investigators looking at data in areas where antiretroviral therapy uptake is high (greater than 30%) people were 40% less likely to acquire HIV than in areas where HIV uptake was low (less than 10%).? Test and treat The ‘Test and Treat’ strategy is also based on the observation that people with very low VLs are less likely to transmit the virus than those with higher VLs. This idea was confirmed by a large multi national trial, HPTN 052, which demonstrated that efffective treatment of HOV reduced HIV transmission to a heterosexual partner by 96%. HIV infected people treated at high CD4 count (median 446 cell/cubic mm) also had improved health outcomes. This result was named “Breathrough of the Year” by Science Magazine