無法檢測到愛滋病毒即無法傳播且「風險為零」

 

無法檢測到愛滋病毒即無法傳播且「風險為零」

Undetectable HIV Is Untransmittable and the 'Risk Is Zero'

Heather Boerner; July 27, 2018

 

 

「如果你正在接受反轉錄病毒治療且達到病毒被抑制到測不到之水準,那麼在性行為過程中你就是不具傳染性的,風險是零」。來自倫敦大學學院的醫學博士Alison Rodger在阿姆斯特丹的 2018年國際愛滋病大會上表示。

 

羅傑(Rodger)在發表PARTNER2研究的結果後並發表聲明,該研究結果顯示,在血清不一致的同性戀伴侶之間,其中愛滋病毒陽性之伴侶當其病毒載量確定受到抑制,則在將近有77,000次的無套性行為中,顯示並未有任一人被感染。其調查結果受到許多的質疑、掌聲、淚水、拍照以及來自國家衛生研究院官員們握手的歡迎。

 

對於那些不願與病人談論數據的醫生來說,「找藉口的時間已結束了」羅傑說。這裡的研究人員說,經過幾十年的規劃和研究,感覺就像一個時代的結束。

來自北卡羅來納大學教堂山分校的醫學博士Myron Cohen表示,「我認為這像是畢業典禮 」,他於2011年站在類似的舞台上,並宣布了來自針對異性戀伴侶具有里程碑意義之HIV預防試驗網絡052研究的類似結果( N Engl J Med2016; 375830-839)。「對我而言,這是始於20世紀90年代,對此一假設大量投資結果的全面實現”科恩解釋道。

 

 

 

信賴區間的上限

PARTNER2研究係延續2015PARTNER之後之研究,根據Medscape醫學新聞報導顯示,PARTNER研究在同性戀和異性戀伴侶中,雖歷經有53,000個無套性行為,但觀察到零個具有傳播之關聯。但在那項研究中,對於同性戀伴侶而言,這一發現並不像對異性戀伴侶那樣強大。研究中沒有足夠的男同性戀者,且他們沒有被追踪足夠長的時間。

 

羅傑解釋說,PARTNER2的目的是「就像我們對異性戀者一樣,也為同性戀者提供相等的證據」。它評估了經治療後達到病毒抑制狀態下的保護作用,看它在針對愛滋病毒陰性的男同性戀者中,當他們在沒有使用安全套的情況下與愛滋病毒陽性伴侶進行接受式肛交時,是否能阻止其感染。研究人員還希望了解其結果,是否符合在PARTNER研究中異性戀伴侶每伴侶-年追蹤之信賴區間上限0.46。對男同性戀者來說,在那項研究中幾乎翻了一倍為0.84

 

PARTNER2之參與者,係招募來自14個歐洲國家中75個地點之972名血清狀態不一致的同性戀伴侶,所有男性都完成了性行為問卷調查。每612個月,HIV陽性的男性接受病毒載量測試,而HIV陰性之男性則接受HIV檢測。


 

 

Undetectable HIV Is Untransmittable and the 'Risk Is Zero'

Heather Boerner; July 27, 2018

 

 

Carl Dieffenbach, Bruce Richman, Alison Rodger, Mike Cohen, and Pietro Vernazza at the International AIDS Conference.

AMSTERDAM — "If you're on suppressive ART, you are sexually noninfectious. The risk is zero," said Alison Rodger, MD, from University College London, here at the International AIDS Conference 2018.

Rodger made the statement after presenting results from PARTNER2 that showed zero linked transmissions after nearly 77,000 condomless sex acts between serodiscordant gay couples in which the HIV-positive partner had a suppressed viral load.

The findings were greeted by questions, applause, tears, photos, and a handshake from officials from the National Institutes of Health.

For physicians hesitant to talk to their patients about the data, "the time for excuses is over," Rodger said.

Researchers here said that after decades of planning and studying, it feels like the end of an era.

"I see this as a graduation ceremony," said Myron Cohen, MD, from University of North Carolina at Chapel Hill, who stood on a similar stage in 2011 and announced similar results for heterosexual couples from the landmark HIV Prevention Trials Network 052 study (N Engl J Med. 2016;375:830-839).

"This is the full realization of very large investments in this hypothesis that, for me, started in the 1990s," Cohen explained.

The Upper Limit of Confidence

PARTNER2 followed the 2015 PARTNER study, showed zero linked transmissions from 53,000 condomless sex acts in gay and heterosexual couples, as reported by Medscape Medical News.

But in that study, the finding was not as robust for gay couples as it was for heterosexual couples. There just weren't enough gay men in the study and they hadn't been followed for long enough.

PARTNER2 was designed to "provide equality of evidence for gay men as we had for heterosexuals," Rodger explained.

It assessed the protective effect of suppressive treatment to see if it would hold up for HIV-negative gay men who had receptive anal sex with HIV-positive partners without a condom.

The researchers also wanted to see whether the results would match the upper confidence interval of 0.46 per couple-year of follow-up reached by heterosexual couples in PARTNER. For the gay men in that study, it was nearly double that, at 0.84.

The 972 serodiscordant gay couples enrolled in PARTNER2 were recruited from 75 sites in 14 European countries. All men completed sexual behavior questionnaires. Every 6 to 12 months, the HIV-positive men underwent viral load testing and the negative men underwent HIV testing.