加拿大关于艾滋病毒暴露前和暴露后预防的指南:2025年更新
Darrell H S Tan1, Mark W Hull2, Stanley O Onyegbule2
1Division of Infectious Diseases (Tan, Onyegbule) and MAP Centre for Urban Health Solutions (Tan, Onyegbule, Ajiboye), St. Michael's Hospital, Toronto Ont.; Department of Medicine (Hull), University of British Columbia, Vancouver, BC; CATIE (Canadian AIDS Treatment Information Exchange) (Arkell), Toronto, Ont.; Clinique de médecine urbaine du Quartier latin and CHUM (Centre hospitalier de l'Université de Montréal) (Baril); Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal (Cox, Lambert), Montréal, Que.; Department of Family Practice, Faculty of Medicine (Harris), University of British Columbia, Vancouver, BC; School of Pharmacy (Kelly), Memorial University of Newfoundland, St. John's, NL; Community-Based Research Centre (Kwag), Vancouver, BC; School of Nursing, University of Ottawa (O'Byrne), Ottawa, Ont.; Department of Emergency Medicine (O'Donnell), St. Paul's Hospital, Vancouver, BC; Cumming School of Medicine (Shukalek), University of Calgary, Calgary, Alta.; Division of Infectious Diseases, Department of Medicine (Singh), University of Alberta, Edmonton, Alta.; Department of Pediatrics, Division of Pediatric Infectious Disease, Division of Adolescent Health and Medicine (Sotindjo), University of British Columbia, Vancouver, BC Children's Hospital, Vancouver, BC; Leslie Dan Faculty of Pharmacy (Swidrovich), University of Toronto, Toronto, Ont.; Centre de recherche du Centre hospitalier de l'Université de Montréal ( Tremblay), Montréal, Que.; Department of Pharmacy (Yoong), St. Michael's Hospital, Toronto, Ont. darrell.tan@gmail.com.
加拿大最新的指导方针提供了多种安全有效的暴露前和暴露后预防 (PrEP和PEP) 方案,以减少新的艾滋病毒感染. 临床医生应评估艾滋病毒风险,并与患者讨论合适的选择.
科学领域:
- 公共卫生 公共卫生
- 传染病管理 传染病管理
- 临床指南 临床指南
背景情况:
- 加拿大每年新增的艾滋病毒感染需要更新关于暴露前和暴露后预防 (PrEP和PEP) 的指导.
- 加拿大卫生研究院 (CIHR) 全加拿大艾滋病毒/艾滋病网络和STBBI临床试验研究更新了2017年的指南.
研究的目的:
- 为加拿大提供PrEP和PEP的最新临床指示和药物治疗方案.
- 为艾滋病毒预防策略制定基于证据的建议.
主要方法:
- 专家小组召开会议,借鉴社区商和系统审查 (搜索到2024年6月).
- 使用正式的证据决策框架和推,评估,开发和评估 (GRADE) 系统的分级.
- 遵守指导方针国际网络原则和研究和评估指导方针II (AGREE II) 的评估报告标准.
主要成果:
- 制定了31条建议和10条良好实践声明.
- 鼓励临床医生评估艾滋病毒风险,并讨论各种PrEP方案 (口服TDF/FTC,按需TDF/FTC,口服TAF/FTC,注射卡博特格拉维尔).
- 首选的PEP方案包括多卢特格拉维尔+TDF/FTC或比克特格拉维尔/TAF/FTC,考虑传播可能性和暴露类型.
结论:
- 加拿大有多种安全有效的PrEP和PEP选择.
- 该指南的实施旨在增加获得生物医学HIV预防的机会.
- 该指南预计将减少加拿大的艾滋病毒发病率.
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