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Diabetes in HIV: the Link to Weight Gain. 艾滋病患者的糖尿病:与体重增加的关系。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-02-01 Epub Date: 2022-11-23 DOI: 10.1007/s11904-022-00642-w
Samuel S Bailin, John R Koethe

Purpose of review: The burden of metabolic diseases, including type 2 diabetes mellitus (T2DM), is rising among persons with HIV (PWH) on antiretroviral therapy (ART). This increase coincides with an aging population and a greater proportion who are overweight/obese. This review summarizes the changing epidemic of T2DM on contemporary ART, the role of weight gain, and therapeutic options.

Recent findings: Recent studies confirm that PWH face an epidemic of obesity and T2DM, similar to the general population. Contemporary ART is associated with greater weight gain and may contribute to the risk of T2DM. Recent advances in medical weight loss therapy offer a way forward in the prevention and treatment of weight-associated T2DM. Weight gain is one of the biggest contributors to T2DM in PWH. Future studies on the role of adipose tissue distribution, adipose tissue function and clinical use of effective weight loss medications may change the paradigm of care for PWH.

综述目的:在接受抗逆转录病毒疗法(ART)的艾滋病病毒感染者(PWH)中,包括 2 型糖尿病(T2DM)在内的代谢性疾病的负担正在增加。这一增长与人口老龄化和超重/肥胖比例增加相吻合。本综述总结了 T2DM 在当代抗逆转录病毒疗法中的流行变化、体重增加的作用以及治疗方案:最近的研究证实,与普通人群相似,残疾人也面临着肥胖和 T2DM 的流行。当代抗逆转录病毒疗法与体重增加有关,可能会增加罹患 T2DM 的风险。医学减重疗法的最新进展为预防和治疗与体重相关的 T2DM 提供了一条出路。体重增加是导致肥胖者患 T2DM 的最大因素之一。未来对脂肪组织分布、脂肪组织功能以及有效减肥药物的临床应用的研究可能会改变 PWH 的治疗模式。
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引用次数: 0
VMMC Programmatic Successes and Challenges: Western Kenya Case Study. VMMC项目成功与挑战:肯尼亚西部案例研究。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2022-12-01 DOI: 10.1007/s11904-022-00644-8
Kawango Agot, Jacob Onyango, Marylyn Ochillo, Elijah Odoyo-June

Purpose of review: The Nyanza region of western Kenya is lauded for impressive coverage of voluntary medical male circumcision (VMMC) and remains the bedrock of the VMMC program in Kenya. We conducted literature review on programmatic successes and challenges of implementing VMMC program in the region.

Recent findings: Responsive stakeholders' engagement, robust policy environment, effective technical working groups, prompt capacity building of health facilities, government support, flexible implementation strategies, and sustained donor funding contributed to the successes of the program that saw circumcision prevalence in Nyanza reach between 75.6 and 85.3% among 15-29-year-olds by 2019. However, the lack of support for early infant circumcision, inadequate domestic financing, and slow pace of service integration into government health facilities continue to undermine the progress towards sustainability. While local ownership of the VMMC program has been demonstrated through its inclusion in county annual health workplans and progressive integration into routine health care, continued dependence on declining external funding threatens its sustainability. Furthermore, Kenya is experiencing a youth bulge with a projected high demand for VMMC which calls for increased resource inputs into the program. Strategies are therefore needed to increase domestic resource inflows into VMMC.

审查目的:肯尼亚西部的Nyanza地区因其令人印象深刻的自愿医疗男性包皮环切(VMMC)的覆盖范围而受到称赞,并且仍然是肯尼亚VMMC计划的基石。我们对该地区实施VMMC计划的成功和挑战进行了文献综述。最近的发现是:利益攸关方积极参与、强有力的政策环境、有效的技术工作组、卫生设施的迅速能力建设、政府支持、灵活的实施战略以及持续的捐助者资助促成了该规划的成功,到2019年,尼扬扎15-29岁人群的包皮环切率达到75.6%至85.3%。然而,缺乏对婴儿早期包皮环切术的支持、国内资金不足以及将服务纳入政府卫生设施的速度缓慢,继续破坏在实现可持续性方面取得的进展。虽然通过将自愿家庭医疗保健方案纳入县年度卫生工作计划和逐步纳入常规卫生保健,证明了地方对自愿家庭医疗保健方案的所有权,但对不断减少的外部资金的持续依赖威胁着其可持续性。此外,肯尼亚正在经历青年人口膨胀,预计对自愿医疗保健的需求很高,这要求增加对该方案的资源投入。因此,需要制定战略,增加国内资源流入志愿医疗保健服务。
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引用次数: 1
Consolidated Overview of Notifiable Adverse Events in the U.S. President's Emergency Plan for AIDS Relief's Voluntary Medical Male Circumcision Program Through 2020. 到2020年,美国总统艾滋病救济紧急计划自愿医疗男性包皮环切计划中应通报不良事件的综合概述。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2022-12-01 DOI: 10.1007/s11904-022-00636-8
Todd Lucas, Caroline Cooney, Amber Prainito, Catherine Godfrey, Valerian Kiggundu, Anne Goldzier Thomas, Renee Ridzon, Carlos Toledo

Purpose of review: Through December 2020, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supported more than 25 million voluntary medical male circumcisions (VMMC) as part of the combined HIV prevention strategy in 15 African countries. PEPFAR monitors defined adverse events (AEs) occurring within 30 days of VMMC through its notifiable adverse event reporting system (NAERS). All NAERS reports through December 2020 were reviewed to quantify AE type, severity, and relation to the VMMC procedure. Interventions to improve client safety based on NAERS findings are described.

Recent findings: Fourteen countries reported 446 clients with notifiable adverse events (NAEs); 394/446 (88%) were determined VMMC-related, representing approximately 18 NAE reports per million circumcisions. Fatalities comprised 56/446 (13%) with 24/56 (43%) of fatalities determined VMMC-related, representing 0.96 VMMC-related fatalities per million circumcisions. The remaining 390 NAEs were non-fatal with 370/390 (95%) VMMC-related. Multiple programmatic changes have been made based on NAERS data to improve client safety. Client safety is paramount in this surgical program designed for individual and population-level benefit. Surveillance of rare but severe complications following circumcision has identified pre-existing or new safety concerns and guided continuous programmatic improvement.

审查目的:截至2020年12月,美国总统艾滋病紧急救援计划(PEPFAR)在15个非洲国家支持了超过2500万例自愿医疗男性包皮环切术(VMMC),作为艾滋病毒综合预防战略的一部分。PEPFAR通过其应通报的不良事件报告系统(NAERS)监测在VMMC后30天内发生的定义不良事件(ae)。审查了截至2020年12月的所有NAERS报告,以量化AE类型、严重程度及其与VMMC程序的关系。本文描述了基于NAERS发现的改善客户安全的干预措施。最近的发现:14个国家报告了446名患者出现应通报的不良事件(NAEs);394/446例(88%)被确定与vmmc相关,代表每百万包皮环切术中约有18例NAE报告。死亡人数占56/446(13%),其中24/56(43%)的死亡与包皮环切术有关,即每百万例包皮环切术中有0.96例与包皮环切术有关。其余390例NAEs为非致死性,其中370/390(95%)与vmmc相关。基于NAERS数据进行了多个程序性更改,以提高客户端安全性。客户安全是最重要的,在这个手术方案设计为个人和人群水平的利益。对包皮环切术后罕见但严重的并发症的监测发现了先前存在的或新的安全问题,并指导了持续的规划改进。
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引用次数: 6
How Does Voluntary Medical Male Circumcision Reduce HIV Risk? 男性自愿医学包皮环切术如何降低艾滋病风险?
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2022-12-01 Epub Date: 2022-10-29 DOI: 10.1007/s11904-022-00634-w
Jessica L Prodger, Ronald M Galiwango, Aaron A R Tobian, Daniel Park, Cindy M Liu, Rupert Kaul

Purpose of review: Voluntary medical male circumcision (VMMC) is a surgical procedure that reduces HIV acquisition risk by almost two-thirds. However, global implementation is lagging, in part due to VMMC hesitancy. A better understanding of the mechanism(s) by which this procedure protects against HIV may increase acceptance of VMMC as an HIV risk reduction approach among health care providers and their clients.

Recent findings: HIV acquisition in the uncircumcised penis occurs preferentially across the inner foreskin tissues, due to increased susceptibility that is linked to elevated inflammatory cytokine levels in the sub-preputial space and an increased tissue density of HIV-susceptible CD4 + T cells. Inflammation can be caused by sexually transmitted infections, but is more commonly induced by specific anaerobic components of the penile microbiome. Circumcision protects by both directly removing the susceptible tissues of the inner foreskin, and by inducing a less inflammatory residual penile microbiome. VMMC reduces HIV susceptibility by removing susceptible penile tissues, and also through impacts on the penile immune and microbial milieu. Understanding these mechanisms may not only increase VMMC acceptability and reinvigorate global VMMC programs, but may also lead to non-surgical HIV prevention approaches focused on penile immunology and/or microbiota.

审查目的:自愿包皮环切术(VMMC)是一种外科手术,可将感染艾滋病毒的风险降低近三分之二。然而,该手术在全球的实施进度缓慢,部分原因是人们对包皮环切术犹豫不决。如果能更好地了解该手术预防艾滋病病毒感染的机制,可能会提高医疗服务提供者及其客户对无包皮环切术作为降低艾滋病病毒感染风险方法的接受度:未实施包皮环切术的阴茎感染艾滋病毒的几率较高,这主要是由于包皮内层组织的易感性增加,而这与包皮下腔炎性细胞因子水平升高以及组织中易感染艾滋病毒的 CD4 + T 细胞密度增加有关。炎症可由性传播感染引起,但更常见的是由阴茎微生物群中的特定厌氧成分诱发。包皮环切术通过直接切除包皮内侧的易感组织和诱导炎症较少的残余阴茎微生物群来保护阴茎。阴茎包皮环切术通过切除易感染的阴茎组织,以及对阴茎免疫和微生物环境的影响,降低对艾滋病毒的易感性。了解这些机制不仅可以提高人们对阴茎包皮环切术的接受度,为全球阴茎包皮环切术项目注入新的活力,还可以开发出以阴茎免疫学和/或微生物群为重点的非手术艾滋病预防方法。
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引用次数: 0
Lessons for Understanding Central Nervous System HIV Reservoirs from the Last Gift Program. 从最后的礼物计划中了解中枢神经系统HIV库的经验教训。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2022-12-01 Epub Date: 2022-10-19 DOI: 10.1007/s11904-022-00628-8
Patricia K Riggs, Antoine Chaillon, Guochun Jiang, Scott L Letendre, Yuyang Tang, Jeff Taylor, Andrew Kaytes, Davey M Smith, Karine Dubé, Sara Gianella

Purpose of review: Deep tissue HIV reservoirs, especially within the central nervous system (CNS), are understudied due to the challenges of sampling brain, spinal cord, and other tissues. Understanding the cellular characteristics and viral dynamics in CNS reservoirs is critical so that HIV cure trials can address them and monitor the direct and indirect effects of interventions. The Last Gift program was developed to address these needs by enrolling altruistic people with HIV (PWH) at the end of life who agree to rapid research autopsy.

Recent findings: Recent findings from the Last Gift emphasize significant heterogeneity across CNS reservoirs, CNS compartmentalization including differential sensitivity to broadly neutralizing antibodies, and bidirectional migration of HIV across the blood-brain barrier. Our findings add support for the potential of CNS reservoirs to be a source of rebounding viruses and reseeding of systemic sites if they are not targeted by cure strategies. This review highlights important scientific, practical, and ethical lessons learned from the Last Gift program in the context of recent advances in understanding the CNS reservoirs and key knowledge gaps in current research.

综述目的:由于对大脑、脊髓和其他组织进行采样的挑战,深部组织HIV库,特别是中枢神经系统内的HIV库,研究不足。了解中枢神经系统库中的细胞特征和病毒动力学至关重要,以便HIV治疗试验能够解决这些问题,并监测干预措施的直接和间接影响。“最后的礼物”计划是为了满足这些需求而制定的,它招募了在生命结束时同意快速研究尸检的无私的艾滋病毒感染者。最近的发现:《最后的礼物》的最新发现强调了中枢神经系统储层的显著异质性、中枢神经系统的划分,包括对广泛中和抗体的不同敏感性,以及HIV通过血脑屏障的双向迁移。我们的研究结果进一步支持了中枢神经系统宿主可能成为病毒反弹和系统部位补种的来源,如果它们不是治疗策略的目标。这篇综述强调了从“最后的礼物”计划中吸取的重要科学、实践和伦理教训,以及在理解中枢神经系统库和当前研究中的关键知识差距方面的最新进展。
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引用次数: 0
The Effects of Medical Male Circumcision on Female Partners' Sexual and Reproductive Health. 男性包皮环切术对女性伴侣性健康和生殖健康的影响。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2022-12-01 Epub Date: 2022-11-11 DOI: 10.1007/s11904-022-00638-6
Supriya D Mehta

Purpose of review: Voluntary medical male circumcision (VMMC) reduces the risk of HIV acquisition by 60% among heterosexual men, provides protection against certain sexually transmitted infections (STI), and leads to penile microbiome composition changes associated with reduced risk of HIV infection. Intuitively, the benefits of VMMC for female sex partners in relation to STI are likely and have been evaluated. The purpose of this review is to examine emerging findings of broader sexual and reproductive health (SRH) benefits of VMMC for female sex partners.

Recent findings: Systematic reviews find strong evidence for beneficial effects of VMMC on female sex partners risk of HPV, cervical dysplasia, cervical cancer, and with likely protection against trichomoniasis and certain genital ulcerative infections. Few studies assess the direct impact of VMMC on the vaginal microbiome (VMB), though several studies demonstrate reductions in BV, which is mediated by the VMB. Studies are lacking regarding male circumcision status and outcomes associated with non-optimal VMB, such as female infertility and adverse pregnancy outcomes. VMMC has positive effects on women's perceptions of sexual function and satisfaction, and perceptions of disease risk and hygiene, without evidence of risk compensation. VMMC has consistent association with a broad range of women's SRH outcomes, highlighting the biological and non-biological interdependencies within sexual relationships, and need for couples-level approaches to optimize SRH for men and women. The paucity of information on VMMC and influence on VMB is a barrier to optimizing VMB-associated SRH outcomes in female partners.

审查目的:男性自愿包皮环切术(VMMC)可将异性恋男性感染 HIV 的风险降低 60%,可预防某些性传播感染(STI),并导致与 HIV 感染风险降低相关的阴茎微生物组构成变化。直觉上,VMMC 对女性性伴侣在性传播感染方面的益处是可能的,并且已经进行了评估。本综述的目的是研究 VMMC 对女性性伴侣更广泛的性健康和生殖健康(SRH)益处的新发现:系统综述发现,有确凿证据表明女性性伴侣感染人类乳头瘤病毒、宫颈发育不良和宫颈癌的风险会因女性子宫内膜异位症而降低,同时还可能预防滴虫病和某些生殖器溃疡感染。很少有研究评估包皮环切术对阴道微生物群(VMB)的直接影响,不过有几项研究表明,阴道微生物群介导的阴道乳头瘤病毒(BV)有所减少。目前还缺乏有关男性包皮环切情况以及与非最佳阴道微生物组相关的结果(如女性不孕和不良妊娠结果)的研究。包皮过长和包茎对女性的性功能和满意度以及疾病风险和卫生观念有积极影响,但没有证据表明存在风险补偿。女性性传播疾病与妇女性健康和生殖健康的广泛结果有着一致的联系,这突出表明了性关系中生物和非生物的相互依存关系,以及需要采取夫妻层面的方法来优化男性和女性的性健康和生殖健康。有关自愿性生育和对自愿性生育的影响的信息很少,这阻碍了优化自愿性生育对女性伴侣性健康和生殖健康影响的工作。
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引用次数: 0
Trends and Clinical Characteristics of HIV and Cerebrovascular Disease in Low- and Middle-Income Countries (LMICs) Between 1990 and 2021. 1990年至2021年期间中低收入国家艾滋病毒和脑血管疾病的趋势和临床特征
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2022-12-01 DOI: 10.1007/s11904-022-00627-9
George Ransley, Stanley Zimba, Yohane Gadama, Deanna Saylor, Laura Benjamin

Purpose of the review: To describe trends and clinical characteristics of HIV and cerebrovascular disease between 1990 and 2021 in LMICs and identify the gaps in our understanding.

Recent findings: In the era of antiretroviral therapy (ART), people living with HIV (PLWH) live longer and risk excess cerebrovascular events due to ageing and HIV-driven factors. Despite the highest burden of HIV infection in low-to-middle income countries, there is underreporting in the literature of cerebrovascular events in this population. We systematically reviewed published literature for primary clinical studies in adult PLWH and cerebrovascular disease in LMICs. The clinical phenotype of cerebrovascular disease among PLWH over the last three decades in LMICs has evolved and transitioned to an older group with overlapping cerebrovascular risk factors. There is an important need to increase research in this population and standardise reporting to facilitate understanding, guide development of appropriate interventions, and evaluate their impact.

综述的目的:描述1990年至2021年间中低收入国家艾滋病毒和脑血管疾病的趋势和临床特征,并确定我们认识上的差距。最新发现:在抗逆转录病毒治疗(ART)时代,艾滋病毒感染者(PLWH)寿命更长,由于衰老和艾滋病毒驱动因素,脑血管事件风险增加。尽管中低收入国家的艾滋病毒感染负担最高,但这一人群的脑血管事件文献报道不足。我们系统地回顾了已发表的关于中低收入国家成人PLWH和脑血管疾病的初步临床研究的文献。在过去的三十年中,低收入国家的PLWH患者的脑血管疾病临床表型发生了演变,并向脑血管危险因素重叠的老年人群过渡。有必要增加对这一人群的研究,并使报告标准化,以促进理解,指导制定适当的干预措施,并评估其影响。
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引用次数: 2
Telehealth Interventions for HIV in Low- and Middle-Income Countries. 中低收入国家的艾滋病毒远程保健干预。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2022-12-01 Epub Date: 2022-09-26 DOI: 10.1007/s11904-022-00630-0
Jessica M Phan, Sangmin Kim, Đoàn Thị Thùy Linh, Lisa A Cosimi, Todd M Pollack

Purpose of review: This review summarizes technology-based interventions for HIV in low- and middle-income countries (LMICs). We highlight potential benefits and challenges to using telehealth in LMICs and propose areas for future study.

Recent findings: We identified several models for using telehealth to expand HIV health care access in LMICs, including telemedicine visits for pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) services, telementoring programs for providers, and virtual peer-support groups. Emerging data support the acceptability and feasibility of these strategies. However, further investigations are needed to determine whether these models are scalable and sustainable in the face of barriers related to cost, infrastructure, and regulatory approval. HIV telehealth interventions may be a valuable approach to addressing gaps along the HIV care cascade in LMICs. Future studies should focus on strategies for expanding existing programs to scale and for assessing long-term clinical outcomes.

综述目的:本综述总结了中低收入国家(LMICs)基于技术的艾滋病干预措施。我们强调了在中低收入国家使用远程医疗的潜在益处和挑战,并提出了未来研究的领域:我们发现了几种利用远程医疗扩大低收入国家艾滋病医疗服务的模式,包括针对暴露前预防(PrEP)和抗逆转录病毒疗法(ART)服务的远程医疗访问、针对医疗服务提供者的远程辅导计划以及虚拟同伴支持小组。新兴数据支持这些策略的可接受性和可行性。然而,面对成本、基础设施和监管审批等方面的障碍,这些模式是否具有可扩展性和可持续性,还需要进一步的调查来确定。艾滋病毒远程保健干预措施可能是解决低收入和中等收入国家艾滋病毒级联护理缺口的一种有价值的方法。未来的研究应重点关注扩大现有项目规模和评估长期临床结果的策略。
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引用次数: 0
Does Voluntary Medical Male Circumcision Reduce HIV Risk in Men Who Have Sex with Men? 自愿包皮环切术能降低男男性行为者感染艾滋病毒的风险吗?
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2022-12-01 DOI: 10.1007/s11904-022-00637-7
Yidie Lin, Yanxiao Gao, Yue Sun, DeAnne Turner, Huachun Zou, Sten H Vermund, Han-Zhu Qian

Purpose of review: To review the evidence on the effect of voluntary medical male circumcision (VMMC) on reducing HIV risk among men who have sex with men (MSM) and assess the limitations of available evidence.

Recent findings: Individual studies have shown conflicting results, but recent meta-analyses have consistently suggested that VMMC was associated with 7 to 23% reductions in HIV prevalence or incidence in MSM, particularly among a subgroup of men who predominantly practice insertive role in anal sex. Mathematical models have also suggested a moderate population-level impact of VMMC intervention. All original studies have been observational and are subject to confounding and bias. Randomized clinical trials (RCTs) are needed to provide strong evidence of assessing the efficacy of VMMC on HIV risk among MSM. VMMC is a promising HIV risk reduction tool for MSM. RCTs are needed to evaluate the efficacy of VMMC intervention.

综述目的:综述自愿医学男性包皮环切术(VMMC)对降低男男性行为者(MSM)艾滋病毒风险影响的证据,并评估现有证据的局限性。最近的发现:个别研究显示出相互矛盾的结果,但最近的荟萃分析一致表明,VMMC与MSM中艾滋病毒流行率或发病率降低7%至23%有关,特别是在主要从事肛交插入作用的男性亚群中。数学模型也表明,VMMC干预对人口水平有中等影响。所有的原始研究都是观察性的,容易混淆和偏倚。需要随机临床试验(rct)来提供强有力的证据来评估VMMC对MSM中艾滋病毒风险的有效性。对于男男性接触者来说,VMMC是一种很有前途的降低艾滋病毒风险的工具。需要随机对照试验来评估VMMC干预的疗效。
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引用次数: 0
Understanding the Evolving Role of Voluntary Medical Male Circumcision as a Public Health Strategy in Eastern and Southern Africa: Opportunities and Challenges. 了解自愿医疗男性包皮环切作为东部和南部非洲公共卫生战略的演变作用:机遇和挑战。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2022-12-01 DOI: 10.1007/s11904-022-00639-5
Anna Bershteyn, Edinah Mudimu, Ingrida Platais, Samuel Mwalili, James E Zulu, Wiza N Mwanza, Katharine Kripke

Purpose of review: Voluntary male medical circumcision (VMMC) has been a cornerstone of HIV prevention in Eastern and Southern Africa (ESA) and is credited in part for declines in HIV incidence seen in recent years. However, these HIV incidence declines change VMMC cost-effectiveness and how it varies across populations.

Recent findings: Mathematical models project continued cost-effectiveness of VMMC in much of ESA despite HIV incidence declines. A key data gap is how demand generation cost differs across age groups and over time as VMMC coverage increases. Additionally, VMMC models usually neglect non-HIV effects of VMMC, such as prevention of other sexually transmitted infections and medical adverse events. While small compared to HIV effects in the short term, these could become important as HIV incidence declines. Evidence to date supports prioritizing VMMC in ESA despite falling HIV incidence. Updated modeling methodologies will become necessary if HIV incidence reaches low levels.

审查目的:自愿男性医学包皮环切术(VMMC)一直是东部和南部非洲(ESA)预防艾滋病毒的基石,并被认为是近年来艾滋病毒发病率下降的部分原因。然而,这些艾滋病毒发病率的下降改变了VMMC的成本效益以及它在不同人群中的差异。最近的发现:数学模型显示,尽管艾滋病毒发病率下降,但在欧空局的大部分地区,VMMC的成本效益仍在继续。一个关键的数据缺口是,随着VMMC覆盖范围的增加,不同年龄组和不同时间的需求生成成本是如何不同的。此外,VMMC模型通常忽略了VMMC的非艾滋病毒影响,例如预防其他性传播感染和医疗不良事件。虽然与艾滋病毒的短期影响相比,这些影响很小,但随着艾滋病毒发病率的下降,这些影响可能变得重要。迄今为止的证据支持尽管艾滋病毒发病率下降,但在欧空局优先考虑VMMC。如果艾滋病毒发病率达到低水平,就需要更新建模方法。
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引用次数: 3
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Current HIV/AIDS Reports
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