8 美国HIV感染者中对感染状况的知晓情况 及估计的传播能力 大约25％不知道已感染约54％的新增感染导致:Marks, et alAIDS 2006;20:大约75％知道已感染约46％的新增感染It is estimated that sexual transmission accounts for 32,000 of the 40,000 new infections each year.Conservative estimates based on the changes in behavior observed once people find out they are infected with HIV indicate that the 25% of people who are unaware that they are infected account for at least 54%, and potentially as much as 70%, of the new sexually transmitted infections each year. The transmission rate among those who don’t know they are infected is 3.5 times higher than for people who know about their HIV infection.The importance of getting these individuals tested and into care that includes both treatment and prevention interventions is critical.存活的感染者/病人数: ~1,110,000每年新感染的数量: ~32,000
9 知晓HIV感染状况与行为改变 知道自己是HIV阳性与不知道者相比，与HIV阴性伙伴的无保护的肛交、阴道交行为降低：68% Meta-analysis of high-risk sexual behavior in personsaware and unaware they are infected with HIV in the U.S.Marks G, et al. JAIDS ;39:446In addition to the benefits of treatment for the individual patient, Screening has significant potential prevention benefits.In a meta-analysis of 11 studies, after people become aware they are infected with HIV, there is 68% less unprotected anal or vaginal intercourse with HIV-negative partners among people who are aware they are HIV-infected, compared with those who are not.These studies included people with long-term HIV infection, as well as those who were recently diagnosed; some were conducted before, and others, after the availability of Highly Active Antiretroviral Therapy. Thus, the finding of reduced risk behavior was not based only on persons who had known of their HIV-positive status for a short time.
19 高效抗逆转录病毒疗法 与艾滋病病死率（美国1994-2003） 14 12 10 8 6 4 2 接受抗病毒疗法的病人 每100人年的死亡 0.90.8120.710接受治疗病人数0.68每100人年的死亡100人年死亡数接受抗病毒疗法的病人0.560.40.340.2This slide illustrates the most important reason for expanded HIV screening: the effectiveness of therapy.Data from CDC’s HIV Outpatient Study shows the dramatic effect of treatment: The proportion of patients on HAART (in yellow) and the rates of death (in pink) – unequivocal evidence for the benefit of therapy for extending life.20.11994199519961997199819992000200120022003年份Palella et al, JAIDS 2006; 43:27.
20 服用抗病毒药病人的死亡情况 73％的死亡发生于开始治疗时CD4细胞<100/mm3的患者 其中，38％的死亡发生在治疗的头1个月，80％发生在治疗的头4个月Source: ART-LINC and ART-CC Groups, Lancet, 2006
22 Kayitenkore K, et al. IAS Toronto. 2006 抗病毒治疗对HIV传播的影响卢旺达 ——HIV 单阳夫妇Project San Francisco随访了1,034对夫妇CD4<200的HIV阳性者接受抗病毒治疗与阳性性伴不接受抗病毒治疗的人相比，其阳性性伴接受抗病毒治疗的人发生血清阳转的几率要小得多(OR, 0.2; 95% CI, )Kayitenkore K, et al. IAS Toronto
23 HIV检测咨询的历史1985199519972000200320062007HIV antibody test available WHO PITC guidelinesVCT in WHO CDC HIV testing guidelinesHIV testing and counselling-policy statement -UNAIDSVCT guideline - UNAIDSPITC in WHO/UNAIDS - policy statement1981: 报告首批患者1982: 定义AIDS1983: 发现HIV1985：ELISA检测1987: 首个治疗药物 (AZT)1995: HAART