国内外艾滋病防治新策略
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SCIENCE 11 JULY 2014 • VOL 345 ISSUE 6193, p166
15
End of AIDS
Why then have some scientists and advocates trumpeted the goal of an “end of AIDS”?
We perceive that they are haunted by the fear of donor fatigue and a loss of momentum in the face of recognized challenges.
SCIENCE 11 JULY 2014 • VOL 345 ISSUE 6193, p166
13
End of AIDS
On the other hand, despite skepticism about eradicating smallpox, the World Health Organization began a campaign in 1958 that focused on vaccination, surveillance, and containment. Twenty years later, smallpox was successfully eradicated.
国内外艾滋病防治新策略
中国疾控中心性艾中心 2014年10月20日
End of the AIDS epidemic
By 2030:
End of AIDS epidemic
By 2020: 90% of all people living with HIV will know their HIV status. 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. 90% of all people receiving antiretroviral therapy will have durable viral suppression.
2
Global HIV Incidence
3
Global HIV Prevalence
4
Global HIV deaths
5
Global age and sex of new HIV infections
6
Global age and sex of new HIV deaths
7
Age-standardized HIV incidence in 2013
随访干预比例 CD4检测率 配偶/固定性伴HIV检测率
21
中国艾滋病抗病毒治疗标准
CD4 ≤200
CD4 ≤350
CD4 ≤500
1111111111111111111222222222222222222222 9999999999999999999000000000000000000000 8888888889999999999000000000011111111112 1234567890123456789012345678901234567890
15.0
7.3 10.0
5.0 0.0
2013
27
难题1：扩大检测后发现晚依然严重
年
2009
新发现 CD4检测 CD4<200 CD4<350 CD4≤500
人数
人数
比例% 比例% 比例%
61626 30458 43.8 58.3 78.8
2010 64338 38275 42.0 57.5 78.7
40.1 4.0
3.0
2.0
0.6
0.4 1.0
2012
0.0 2013
最近一年接受检测并知道结果比例 最近一个月商业性行为坚持用安全套的比例 HIV抗体阳性率(%)
26
MSM安全套使用、HIV检测及HIV感染率
- 哨点监测结果
比例（%）
HIV抗体阳性率（%）
100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0
检测人次数
新发现病例数
检测机构数
20
感染者随访管理不断改善
比去年
%
100 80
91.9 94.6
74.6
85.7
89.6
80.6
70.5
81.3
95.4 1-5% 91.0
86.9
60
55.7 56.6
71.1
40
45.3 34.7 48.3 48.4 54.2
60.5
32.8
20
0 2007 2008 2009 2010 2011 2012 2013 年
22
抗病毒治疗进展
2312个县(区) 3733个医疗机构开展抗病毒治疗； 成人在治 223,962人， 86.9% ； 儿童在治 3,527人， 85.5% 。
>7万
23
吸毒人群干预
美沙酮维持治疗 2004年启动，截至2013年12月31日，全国28个省市共开设
763个美沙酮治疗门诊，ቤተ መጻሕፍቲ ባይዱ中29辆流动车；另有325个延伸服 药点。累计治疗41.27万人，在治人数20.17万人。
清洁针具交换 2004年启动，截止2013年底，共有 针具交换点 898个，
月均参加针具交换 41,761人。
24
控制HIV经性传播
2004年，全国各级疾控 中心成立高危人群干预工作 队，重点控制艾滋病经性途 径传播。
25
暗娼安全套使用、HIV检测及HIV感染率
- 哨点监测结果
比例(%) HIV抗体阳性率（%）
When these targets are achieved, at least 73% of all people living with HIV worldwide will be virally suppressed. Modelling demonstrates that achieving these targets by 2020 will enable us to end the AIDS epidemic by 2030.
SCIENCE 11 JULY 2014 • VOL 345 ISSUE 6193, p166
16
S82 • CID 2014:59 (Suppl 2) • Fauci et al
17
End of AIDS in Cambodia
18
End of AIDS in Cambodia
Chhi Vun M et al. Journal of the International AIDS Society 2014, 17:18905
42.8 29.1 5.0
2008
最近六个月肛交时坚持使用安全套比例 接受检测并知道结果比例 HIV抗体阳性检出率
44.9
49.0
44.7 42.6
6.4
5.7
50.4
46.7
43.3 43.2
6.3
6.7
2009
2010
2011
2012
50.0 45.0 40.0 35.0 30.0
48.0 25.0 45.6 20.0
(
百 40
45.032718
9694
万 ）
19.68552659.3091287.71162434.2859157462 20
8207
3683
100000
90000
80000
70000 新 60000 发 50000 现
病 40000 例 30000 数 20000
10000
0
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 年份
SCIENCE 11 JULY 2014 • VOL 345 ISSUE 6193, p166
14
End of AIDS
Historically, some earlier optimistic predictions related to HIV have not met with success. These include the announcement in 1984 that an AIDS vaccine was forthcoming and early hope that ART would eradicate HIV infection. The potential of ART to control the HIV epidemic through a “test and treat” approach faces stark realities.
9.0
8.0
7.3
7.0
6.4
6.3 6.7
6.0
5.7 5.0
5.0
4.2
4.0
3.0
3.0
2.0 0.9 1.3 1.4 1.0
0.0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
29
19
2004-2013年全国检测工作进展
90119
120
82434
检 100
74517 110.838445 64338 101.269773
测 人 80 次 数 60
47606
44070 40711
48161
61626 56362
84.210114
64.604323
55.587269
14571
18367 16876
8
Age-standardized HIV prevalence in 2013
9
Age-standardized HIV mortality in 2013
10
End of AIDS
11
End of AIDS
12
End of AIDS
In 1971, the United States launched a “war on cancer,” increasing funding for cancer research. Although great progress has been made in our understanding, diagnosis, and management of cancer, this war has not yet been won. With a few exceptions, cures are rare, disparities in cancer outcomes remain, and investments in research are in question.
2011 74517 52937 42.1 56.8 79.8
2012 82434 65339 38.1 54.9 79.6
2013 90119 76240 37.0 54.9 79.8
28
难题2：MSM人群感染率持续上升
HIV 感染率（%）
2003-2013年MSM哨点监测HIV抗体阳性率
10.0
100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0
58.5
63.0
39.2
39.3
0.8
0.6
2008
2009
61.1 33.9
0.5 2010
65.7 37.3
0.5 2011
10.0
9.0
8.0
68.6
69.3 7.0
6.0
5.0
36.5
15
End of AIDS
Why then have some scientists and advocates trumpeted the goal of an “end of AIDS”?
We perceive that they are haunted by the fear of donor fatigue and a loss of momentum in the face of recognized challenges.
SCIENCE 11 JULY 2014 • VOL 345 ISSUE 6193, p166
13
End of AIDS
On the other hand, despite skepticism about eradicating smallpox, the World Health Organization began a campaign in 1958 that focused on vaccination, surveillance, and containment. Twenty years later, smallpox was successfully eradicated.
国内外艾滋病防治新策略
中国疾控中心性艾中心 2014年10月20日
End of the AIDS epidemic
By 2030:
End of AIDS epidemic
By 2020: 90% of all people living with HIV will know their HIV status. 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy. 90% of all people receiving antiretroviral therapy will have durable viral suppression.
2
Global HIV Incidence
3
Global HIV Prevalence
4
Global HIV deaths
5
Global age and sex of new HIV infections
6
Global age and sex of new HIV deaths
7
Age-standardized HIV incidence in 2013
随访干预比例 CD4检测率 配偶/固定性伴HIV检测率
21
中国艾滋病抗病毒治疗标准
CD4 ≤200
CD4 ≤350
CD4 ≤500
1111111111111111111222222222222222222222 9999999999999999999000000000000000000000 8888888889999999999000000000011111111112 1234567890123456789012345678901234567890
15.0
7.3 10.0
5.0 0.0
2013
27
难题1：扩大检测后发现晚依然严重
年
2009
新发现 CD4检测 CD4<200 CD4<350 CD4≤500
人数
人数
比例% 比例% 比例%
61626 30458 43.8 58.3 78.8
2010 64338 38275 42.0 57.5 78.7
40.1 4.0
3.0
2.0
0.6
0.4 1.0
2012
0.0 2013
最近一年接受检测并知道结果比例 最近一个月商业性行为坚持用安全套的比例 HIV抗体阳性率(%)
26
MSM安全套使用、HIV检测及HIV感染率
- 哨点监测结果
比例（%）
HIV抗体阳性率（%）
100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0
检测人次数
新发现病例数
检测机构数
20
感染者随访管理不断改善
比去年
%
100 80
91.9 94.6
74.6
85.7
89.6
80.6
70.5
81.3
95.4 1-5% 91.0
86.9
60
55.7 56.6
71.1
40
45.3 34.7 48.3 48.4 54.2
60.5
32.8
20
0 2007 2008 2009 2010 2011 2012 2013 年
22
抗病毒治疗进展
2312个县(区) 3733个医疗机构开展抗病毒治疗； 成人在治 223,962人， 86.9% ； 儿童在治 3,527人， 85.5% 。
>7万
23
吸毒人群干预
美沙酮维持治疗 2004年启动，截至2013年12月31日，全国28个省市共开设
763个美沙酮治疗门诊，ቤተ መጻሕፍቲ ባይዱ中29辆流动车；另有325个延伸服 药点。累计治疗41.27万人，在治人数20.17万人。
清洁针具交换 2004年启动，截止2013年底，共有 针具交换点 898个，
月均参加针具交换 41,761人。
24
控制HIV经性传播
2004年，全国各级疾控 中心成立高危人群干预工作 队，重点控制艾滋病经性途 径传播。
25
暗娼安全套使用、HIV检测及HIV感染率
- 哨点监测结果
比例(%) HIV抗体阳性率（%）
When these targets are achieved, at least 73% of all people living with HIV worldwide will be virally suppressed. Modelling demonstrates that achieving these targets by 2020 will enable us to end the AIDS epidemic by 2030.
SCIENCE 11 JULY 2014 • VOL 345 ISSUE 6193, p166
16
S82 • CID 2014:59 (Suppl 2) • Fauci et al
17
End of AIDS in Cambodia
18
End of AIDS in Cambodia
Chhi Vun M et al. Journal of the International AIDS Society 2014, 17:18905
42.8 29.1 5.0
2008
最近六个月肛交时坚持使用安全套比例 接受检测并知道结果比例 HIV抗体阳性检出率
44.9
49.0
44.7 42.6
6.4
5.7
50.4
46.7
43.3 43.2
6.3
6.7
2009
2010
2011
2012
50.0 45.0 40.0 35.0 30.0
48.0 25.0 45.6 20.0
(
百 40
45.032718
9694
万 ）
19.68552659.3091287.71162434.2859157462 20
8207
3683
100000
90000
80000
70000 新 60000 发 50000 现
病 40000 例 30000 数 20000
10000
0
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 年份
SCIENCE 11 JULY 2014 • VOL 345 ISSUE 6193, p166
14
End of AIDS
Historically, some earlier optimistic predictions related to HIV have not met with success. These include the announcement in 1984 that an AIDS vaccine was forthcoming and early hope that ART would eradicate HIV infection. The potential of ART to control the HIV epidemic through a “test and treat” approach faces stark realities.
9.0
8.0
7.3
7.0
6.4
6.3 6.7
6.0
5.7 5.0
5.0
4.2
4.0
3.0
3.0
2.0 0.9 1.3 1.4 1.0
0.0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
29
19
2004-2013年全国检测工作进展
90119
120
82434
检 100
74517 110.838445 64338 101.269773
测 人 80 次 数 60
47606
44070 40711
48161
61626 56362
84.210114
64.604323
55.587269
14571
18367 16876
8
Age-standardized HIV prevalence in 2013
9
Age-standardized HIV mortality in 2013
10
End of AIDS
11
End of AIDS
12
End of AIDS
In 1971, the United States launched a “war on cancer,” increasing funding for cancer research. Although great progress has been made in our understanding, diagnosis, and management of cancer, this war has not yet been won. With a few exceptions, cures are rare, disparities in cancer outcomes remain, and investments in research are in question.
2011 74517 52937 42.1 56.8 79.8
2012 82434 65339 38.1 54.9 79.6
2013 90119 76240 37.0 54.9 79.8
28
难题2：MSM人群感染率持续上升
HIV 感染率（%）
2003-2013年MSM哨点监测HIV抗体阳性率
10.0
100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0
58.5
63.0
39.2
39.3
0.8
0.6
2008
2009
61.1 33.9
0.5 2010
65.7 37.3
0.5 2011
10.0
9.0
8.0
68.6
69.3 7.0
6.0
5.0
36.5