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В Англии лечение ВИЧ начинают с целью профилактики

В Англии лечение ВИЧ начинают с целью профилактики

Все больше людей в Великобритании начинают прием антиретровирусной терапии на более ранних стадиях с целью снижения риска передачи инфекции другим

В Великобритании отмечается растущий интерес ВИЧ-положительных людей к терапии с целью профилактики, что подтверждается двукратным увеличением числа лиц, начинающих терапию при высоких показателях CD4-лимфоцитов, за последние пять лет. В 2013 году, у 49% ВИЧ-позитивных лиц, начинающих лечение, уровень CD4 превышал 350 клеток/мм3, а у 27% - 500 клеток/мм3.

Согласно некоторым «Руководствам по лечению ВИЧ-инфекции», антиретровирусную терапию рекомендуется начинать при уровне CD4-лимфоцитов 500 клеток/мм3 или выше. Однако авторы Великобританского «Руководства» не находят четких доказательств тому, что это приведет к улучшению прогноза заболевания, и в большинстве случаев продолжают рекомендовать начало терапии при CD4 на уровне около 350 клеток/мм3.

Отметим, что с 2012 года в Великобритании, согласно «Руководству по лечению ВИЧ-инфекции» врачам следует информировать всех своих пациентов о данных, подтверждающих эффективность использования антиретровирусной терапии в качестве профилактики передачи инфекции половым партнёрам, и что любой желающий принимать АРТ с этой целью, может начинать терапию независимо от уровня CD4-лимфоцитов.

В 2008 году 75% из 57 752 ВИЧ-положительных пациентов принимали АРТ. К 2013 году этот показатель возрос до 86% (из 77 702 лиц с установленным диагнозом ВИЧ-инфекции). 90% из них удерживают неопределяемую вирусную нагрузку через год после начала терапии (хотя среди пациентов в возрасте до 24 лет этот показатель составляет всего 77%).

В Англии лечение ВИЧ начинают с целью профилактики

Комментарий AIDSmap.com: в некоторых кругах, Великобритания подвергается критике за свое нежелание увеличить порог CD4-лимфоцитов, используемый в качестве показания для начала лечения. Однако вышеприведенные данные показывают, что стратегия информирования пациентов о превентивном потенциале раннего начала АРТ (при более высоких показателях CD4-лимфоцитов), и предоставление самим пациентам права выбора времени для начала терапии - является эффективной стратегией. Эпидемиологи указывают на то, что охват британского населения терапией уже находится на достаточно высоком уровне, и что более жёсткие рекомендации не смогут значительно повлиять на общее число лиц, получающих антиретровирусную терапию.

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