近日，刊登在Cochrane Reviews上的一篇文章中，询证医学的研究者指出，HIV感染的高危人群可以通过服用抗逆转录病毒药物来降低其获得感染风险。抗逆转录病毒的疗法（ART）是专门针对疾病达到某一程度时候对感染者所进行的疗法，抗逆转录病毒药物也被开始用于高危人群，药物的使用是为了起到暴露前预防（PrEP）的作用，PrEP通常来说具有争议性，不仅仅是因为未感染的人群会产生对药物的耐药以及产生某些副作用比如肾脏毒性、骨密度流失等，而且是因为PrEP提供的保护或许会鼓励人群进行高危行为，如性行为等。
研究者分析了6组试验的数据，这6组试验中，研究者检测了每日口服一定剂量的替诺福韦酯（TDF）（加或者不加恩曲他滨<FTC>），相比服用安慰剂时产生的效应。试验中包括9849个参与者，来自4组独立试验和8813个参与者的实验结果揭示了TDF加上FTC可以降低大约一半的HIV感染风险；来自两组的试验和4027个参与者，结果显示，单独服用TDF可以降低约2/3的HIV感染风险。
研究者表示，抗逆转录病毒药物的服用可以降低高危人群HIV感染的风险，试验结果显示，服用抗逆转录病毒药物后，参与者并没有任何严重的副作用。最终研究者表示，俄日来还需要深入的研究来证明是否PrEP真的有必要，当然目前来看这种方法是一种新的安全可靠的方法。当然了当前还存在很多问题，比如我们如何做来确保ART的计划等等。（生物谷Bioon.com）
编译自：Drugs Used to Treat HIV Also Reduce Risk of HIV Infection, Review Suggests
doi:10.1002/14651858.CD007189.pub32
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Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals
Charles I Okwundu1,*, Olalekan A Uthman1, Christy AN Okoromah2
Background More than 30 years into the global HIV/AIDS epidemic, infection rates remain alarmingly high, with over 2.7 million people becoming infected every year. There is a need for HIV prevention strategies that are more effective. Oral antiretroviral pre-exposure prophylaxis (PrEP) in high-risk individuals may be a reliable tool in preventing the transmission of HIV. Objectives To evaluate the effects of oral antiretroviral chemoprophylaxis in preventing HIV infection in HIV-uninfected high-risk individuals. Search methods We revised the search strategy from the previous version of the review and conducted an updated search of MEDLINE, the Cochrane Central Register of Controlled Trials and EMBASE in April 2012. We also searched the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing trials. Selection criteria Randomised controlled trials that evaluated the effects of any antiretroviral agent or combination of antiretroviral agents in preventing HIV infection in high-risk individuals Data collection and analysis Data concerning outcomes, details of the interventions, and other study characteristics were extracted by two independent authors using a standardized data extraction form. Relative risk with a 95% confidence interval (CI) was used as the measure of effect. Main results We identified 12 randomised controlled trials that meet the criteria for the review. Six were ongoing trials, four had been completed and two had been terminated early. Six studies with a total of 9849 participants provided data for this review. The trials evaluated the following: daily oral tenofovir disoproxil fumarate (TDF) plus emtricitabine (FTC) versus placebo; TDF versus placebo and daily TDF-FTC versus intermittent TDF-FTC. One of the trials had three study arms: TDF, TDF-FTC and placebo arm. The studies were carried out amongst different risk groups, including HIV-uninfected men who have sex with men, serodiscordant couples and other high risk men and women. Overall results from the four trials that compared TDF-FTC versus placebo showed a reduction in the risk of acquiring HIV infection (RR 0.51; 95% CI 0.30 to 0.86; 8918 participants). Similarly, the overall results of the studies that compared TDF only versus placebo showed a significant reduction in the risk of acquiring HIV infection (RR 0.38; 95% CI 0.23 to 0.63, 4027 participants). There were no significant differences in the risk of adverse events across all the studies that reported on adverse events. Also, adherence and sexual behaviours were similar in both the intervention and control groups. Authors' conclusions Finding from this review suggests that pre-exposure prophylaxis with TDF alone or TDF-FTC reduces the risk of acquiring HIV in high-risk individuals including people in serodiscordant relationships, men who have sex with men and other high risk men and women.
