公衆衛生84巻12号

2020年12月発行

特集 2030年に向けたHIV/AIDS対策

TasP・U＝U・PrEP—抗レトロウイルス薬を使ったHIV予防

著者： 田沼順子¹

所属機関： ¹国立研究開発法人国立国際医療研究センターエイズ治療・研究開発センター

ページ範囲：P.774 - P.779

【ポイント】
◆抗レトロウイルス療法(ART)により血中HIV-RNAが検出限界未満なら他者へのHIV感染は起こらない．
◆曝露前予防(PrEP)は，世界の多くの地域で標準的に行われている．
◆U＝UとPrEPの推進により，多くの地域で新規HIV感染者数が減っている．

参考文献

1)Worm SW, et al:Risk of myocardial infarction in patients with HIV infection exposed to specific individual antiretroviral drugs from the 3 major drug classes:the data collection on adverse events of anti-HIV drugs(D:A:D)study. J Infect Dis 201:318-330, 2010

2)Strategies for Management of Antiretroviral Therapy(SMART)Study Group, et al:CD4＋ count-guided interruption of antiretroviral treatment. N Engl J Med 355:2283-2296, 2006

3)INSIGHT START Study Group, et al:Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. N Engl J Med 373:795-807, 2015

4)Cohen MS, et al:Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 365:493-505, 2011

5)Cohen MS, et al:Antiretroviral Therapy for the Prevention of HIV-1 Transmission. N Engl J Med 375:830-839, 2016

6)Cohen J:HIV prevention. Halting HIV/AIDS epidemics. Science 334:1338-1340, 2011

7)Joint United Nations Programme on HIV/AIDS:90-90-90 An ambitious treatment target to help end the AIDS epidemic. UNAIDS/JC2684. October 2014　http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf

8)Rodger AJ, et al:Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy［published correction appears in JAMA. 2016 Aug 9;316(6):667］［published correction appears in JAMA. 2016 Nov 15;316(19):2048］. JAMA 316:171-181, 2016

9)Rodger AJ, et al:Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy(PARTNER):final results of a multicentre, prospective, observational study. Lancet 393:2428-2438, 2019

10)Bavinton BR, et al:Viral suppression and HIV transmission in serodiscordant male couples:an international, prospective, observational, cohort study. Lancet HIV 5:e438-e447, 2018

11)Prevention Access Campaign. Consensus Statement, July 2016　https://www.preventionaccess.org/consensus

12)The Lancet Hiv:U＝U taking off in 2017. Lancet HIV 4:e475, 2017

13)Grant RM, et al:Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 363:2587-2599, 2010

14)Centers for Disease Control and Prevention(CDC):Interim guidance:preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR Morb Mortal Wkly Rep 60:65-68, 2011

15)Baeten JM, et al:Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med 367:399-410, 2012

16)Hosek SG, et al:The acceptability and feasibility of an HIV preexposure prophylaxis(PrEP)trial with young men who have sex with men. J Acquir Immune Defic Syndr 62:447-456, 2013

17)Grohskopf LA, et al:Randomized trial of clinical safety of daily oral tenofovir disoproxil fumarate among HIV-uninfected men who have sex with men in the United States. J Acquir Immune Defic Syndr 64:79-86, 2013

18)Thigpen MC, et al:Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med 367:423-434, 2012

19)Choopanya K, et al:Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand(the Bangkok Tenofovir Study):a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 381:2083-2090, 2013

20)World Health Organization. What's the 2＋1＋1? Event-driven oral pre-exposure prophylaxis to prevent HIV for men who have sex with men:Update to WHO's recommendation on oral PrEP. World Health Organization, Geneva, 2019

21)Grant RM, et al:Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men:a cohort study. Lancet Infect Dis 14:820-829, 2014

22)Marcus JL, et al:No evidence of sexual risk compensation in the iPrEx trial of daily oral HIV preexposure prophylaxis. PLoS ONE 8:e81997, 2013

23)Molina J, et al:On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection. N Engl J Med 373:2237-2246, 2015

24)Molina J, et al:Efficacy, safety, and effect on sexual behaviour of on-demand pre-exposure prophylaxis for HIV in men who have sex with men:an observational cohort study. Lancet HIV 4:e402-e410, 2017

25)World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva, World Health Organization, Geneva, 2015

26)ギリアド・サイエンシズ株式会社：プレスリリース．2020年3月　https://www.gilead.co.jp/-/media/japan/pdfs/press-releases/03-10-2020/croi-discover_200310.pdf?la=ja-jp＆hash=3AAA86C9603DD8FEF7D8BC75D05DA3B5

27)Landovitz RJ, et al. Pre-exposure Prophylaxis containing long-acting injectable cabotegravir is safe and highly effective for cisgender men and transgender women who have sex with men, #OAXLB01, AIDS 2020, San Francisco, 2020

28)Public Health England. Progress towards ending the HIV epidemic in the United Kingdom. 2018 report. November 2018, updated June 2019　(https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/821273/Progress_towards_ending_the_HIV_epidemic_in_the_UK.pdf)(Accessed July 31, 2020)