暴露前預防性投藥對HIV感染控制的影響

The Impact of Pre-exposure Prophylaxis on HIV Infection Control

自高效能抗反轉錄病毒療法（highly active antiretroviral therapy，HAART）自1997年問世以來，愛滋病患的死亡率已經大幅降低，但每年全球依舊增加百萬新的感染個案，因此聯合國愛滋病聯合規劃署提出「90－90－90」的目標，期望能有效控制愛滋病的蔓延。目前藥品的治療效果日益精進，病人與大眾對疾病的了解程度也逐年增加，加上政府與民間機關大力推行政策與衛教，確實已經降低不少新增案例，但距離目標仍有一段距離，因此愛滋病專家提出以暴露前預防性投藥（pre-exposure prophylaxis，PrEP）的方式來使疾病防疫的面向更加完整。目前針對PrEP的研究都顯示其可有效降低感染的發生，保護力在不同族群約40～90％之間，其中以男性間的性行為最為有效，影響PrEP保護力的最大因素是藥物的遵從性，不佳的服藥遵從性可能降低保護力。在研究中也觀察到使用藥物後演變的風險補償行為，例如減少保險套使用，其他性傳播感染疾病可能增加的疑慮等，可能影響個人的健康狀態，性傳播感染疾病甚至可能會降低tenofovir在目標組織的濃度。因此在推行PrEP時，應有完整的衛教以及配套措施，才能增加PrEP的功效，並減少相關風險的發生。PrEP確實能使愛滋病控制邁向一個新的里程碑，如能有適當的政策配合與推動，輔以完整的衛教與追蹤篩檢配套措施，加上社會大眾的了解及包容，相信能讓我們更接近愛滋零傳染的目標。 The mortality associated with human immunodeficiency virus infection has declined with current treatment and public health policy. For better disease control, UNAIDS established a new strategy on HIV management and a new, ambitious treatment target. Achieving these targets by 2020 will potentially end the AIDS epidemic by 2030, which in turn will generate profound health and economic benefits. Although many strategies had been implemented to achieve these targets, further interventions are required. Pre-exposure Prophylaxis (PrEP) is key to promote current strategies. Current clinical trials indicate that PrEP offers great protection from HIV infection depending on various populations. But sadly, no strategy is perfect. PrEP with poor adherence provides not only poor protection but also potentially increase resistant mutations. For this reason, we need further education and support policy to enhance patient's adherence. PrEP is definitely a landmark for HIV infection control. It requires more support from different sectors to make it better. It also needs more empathy and tolerance given from others. I believe that we can bring us closer to the goal of zero HIV infection in the future.