抗病毒治疗阻断HIV单阳家庭内传播效果的Meta分析  

Antiretroviral therapy to block transmission in HIV discordant couples:a meta-analysis

作　　者：冯孟贤 刘民[1] 刘珏[1] 陈京[1] 

机构地区：[1]北京大学公共卫生学院,北京100191

出　　处：《中国艾滋病性病》2015年第8期668-672,共5页Chinese Journal of Aids & STD

基　　金：国家十二五重大专项"我国艾滋病流行趋势;疫情评估和预测数学模型研究"(2012ZX10001001)~~

摘　　要：目的通过Meta分析,了解抗病毒治疗（ART）阻断艾滋病病毒（HIV）单阳家庭内传播的效果。方法系统检索PubMed、Ovid、Web of science、Cochrane Central Register of Controlled Trials、CNKI、万方、维普等数据库,检索时间为1987年1月至2014年8月,纳入有关HIV阳性配偶ART阻断家庭内传播的文献,评价指标为家庭内传播的相对危险度（RR）。采用Stata软件进行异质性检验,计算合并RR值及其95%可信区间（CI）值,并根据性别、CD＋4T淋巴细胞（简称CD4细胞）水平及国家收入水平进行亚组分析。结果共纳入16篇文献,包括1篇随机对照试验研究和15篇队列研究。Meta分析显示：ART阻断单阳家庭内传播的合并效应量RR=0.36（95%CI：0.26～0.50）,表明与没有接受ART的单阳家庭相比,ART使HIV家庭内传播风险降低64%。亚组分析显示,与未治疗组相比,ART可使单阳家庭内男传女、女传男的风险分别降低63%和25%;在CD4细胞〈200个/μL、200～350个/μL、〉350个/μL时开始ART治疗,家庭内传播的风险分别降低74%、34%和59%;ART使中低收入国家和高收入国家人群的HIV家庭内传播风险分别降低66%和27%。结论抗病毒治疗可以降低HIV单阳家庭内传播的风险。并且对男传女的阻断效果优于女传男的家庭;当CD4细胞〉350个/μL或者〈200个/μL时,开始治疗的阻断效果优于CD4细胞200～350个/μL时;中低收入国家人群的阻断效果优于高收入国家。Objective To assess the effectiveness of antiretroviral therapy（ART）in blocking transmission in HIV discordant couples.Methods A comprehensive searching was carried out in PubMed,Ovid,Web of science,Cochrane Central Register of Controlled Trials,CNKI,WanFang and VIP electronic databases in the period from January 1987 to August 2014.Papers about HIV index spouse taking ART to block transmission to the negative spouse were enrolled.Indicator for assessment was the relative risk（RR）of transmission.Analysis was conducted using Stata to test homogeneity and pool data.Subgroup analysis was performed by gender of index spouse,CD4 counts levels,and settings of country income.Results Sixteen papers were collected including one RCT and fifteen cohort studies.Meta analysis showed that the pooled RR value of ART to block transmission in HIV discordant couples was 0.36（95%CI：0.26～0.50）,indicating that ART reduced 64% risk of transmission compared to ARTnagative couples.Subgroup analysis showed that ART reduced 63% transmission from man to woman and 25%transmission from woman to man in discordant couples compared to ART-nagative groups respectively.Initiation of ART with CD4 counts levels（〈200,200～350,350〉cells/μL）,risk of transmission reduced 74%,34% and 59%,respectively.ART reduced transmission between discordant couples for 66% in low/middle income countries and27% in high income countries. Conclusion Antiretroviral therapy was proved to reduce the risk of transmission in HIV discordant couples.Effectiveness of blocking was better in couples of man-to-woman than woman-to-man and was better in low/middle income countries than high income countries.

关 键 词：艾滋病病毒 抗病毒治疗 单阳家庭 META分析 

分 类 号：R373.9[医药卫生—病原生物学]