Wang Hui|, director of the AIDS Medical Center of the Shenzhen Third Hospital, said: What are the new changes in the treatment of HIV-infected people?

Ji Yuanyuan, 21st Century Business Herald reporter, reported from Shanghai In the past 10 years, China's AIDS prevention and control work has made great achievements. According to the latest statistics of the National Health Commission, as of the end of October 2020, 1.045 million cases of HIV infection were reported nationwide, and the overall epidemic situation continued to be at a low epidemic level.

The popularization and progress of HIV prevention and treatment have made the once incurable AIDS a preventable, controllable and long-term manageable chronic disease. Treatment coverage and success rates for people living with HIV are now more than 90 percent, and antiviral therapy has significantly extended the lifespan of people living with HIV.

However, with the continuous development of AIDS treatment drugs, stabilizing the disease and ensuring the treatment effect by reducing the viral load in a short period of time is no longer the only goal pursued by HIV-infected people. HIV patients need to take drugs for life once diagnosed, so in addition to lasting viral suppression, they have increasingly high requirements for the safety, simplicity and affordability of long-term medication. As a result, making patients live a better life and have a higher quality of life has gradually become an important goal in the current treatment of HIV-infected people.

In order to enhance the people's understanding of AIDS, the 21st Century Business Herald "Famous Doctors Say" column interviewed Professor Wang Hui, director of the AIDS Medical Center of the Third People's Hospital of Shenzhen (the Second Affiliated Hospital of Southern University of Science and Technology), and asked her to introduce us to how to standardize the use of AIDS drugs and help AIDS patients have a higher quality of life.

21st Century: Could you please tell us about the current epidemiological situation of AIDS and the current status of diagnosis and treatment? And what are the urgent needs to be met?

Wang Hui: The EPIDEMIC in China has undergone very big changes, and before 2009, AIDS was mainly transmitted by blood, mother and child, and sex. After 2009, the population of the spread has changed a lot.

In recent years, the state has taken a series of AIDS prevention measures, for example, requiring every blood bank donor to have HIV tested for HIV, eliminating the blood transmission of blood donors from the root. At the same time, the state began to prevent and control the mother-to-child transmission of AIDS, after effective antiviral treatment and intervention, HIV-positive pregnant women can now basically reach a level close to elimination, especially in the first-tier cities of beijing, Shanghai, Guangzhou, and Shenzhen, basically eliminating mother-to-child transmission of AIDS. In terms of drug abuse, with the change of the times, the control of drugs has become more and more stringent, and the spread of such groups has gradually disappeared. As for sexual transmission, according to the data released in 2020, the national sexual transmission reached about 98%, in other words, the current AIDS transmission is mainly based on sexual transmission.

In sexual transmission, especially the number of sexual transmission of male homosexual groups shows a clear upward trend year by year, and the transmission population is showing a younger trend in developed areas, for example, in Tianjin, same-sex transmission has reached more than 70%, and Shenzhen has reached more than 60%.

21st Century: Previously, many reports showed that the spread of AIDS among the elderly population is not optimistic, how do you think about this phenomenon? What is the current living condition of the elderly with AIDS?

Wang Hui: At present, there are indeed an increasing number of elderly people infected with HIV virus, mainly due to two reasons. On the one hand, since 2004, antiviral therapy has gone through twenty years in China, and the population that received HIV antiviral treatment in the past has become the elderly; on the other hand, in Guangxi, Sichuan and other provinces, the HIV infection rate of the elderly is rising, and there are also many social factors, which will occur unsafe sex, resulting in a relative increase in the proportion of HIV infection rate.

With the growth of age, chronic diseases continue, and these diseases need to take long-term blood pressure, lipid lowering, uric acid lowering and other drugs, if it is HIV-infected people in the patient's age increases, taking drugs will appear to be the interaction between drugs and drugs, especially some drugs may be mixed with HIV antiviral therapy drugs, which will lead to ineffective results. In fact, some new drugs have overcome these problems, for example, Pitovic can allow 80% or even 90% of patients to take drugs together without interference between drugs, these drugs will play a better role if they enter medical insurance.

21st Century: Based on your clinical experience, what are the specific symptoms that occur if a patient is infected with HIV? In terms of SCREENING for HIV, what are the main existing tests?

Wang Hui: After HIV infection, most people will not have specific symptoms for a long time, so HIV cannot be diagnosed based on symptoms. And if you wait until symptoms appear, it means that the patient's condition has progressed to an advanced stage. International and domestic are advocating independent testing, if there is a high-risk sexual behavior of the population should be self-tested, the earlier the test, the better.

At present, the clinical use of ELISA antigen antibody detection method for HIV virus detection is advocated, and through years of reagent updates, the detection method has been developed to the fourth generation of ELISA antigen antibody detection reagent. Some advanced patients because of impaired immune function, antibody expression is not particularly obvious, after there is a new supplementary test, HIV viral load detection, need to see how much HIV virus is in each milliliter of blood, this method can be detected mainly in designated hospitals around the world, but the general general hospital for HIV quantitative detection is not popular enough. Therefore, it is recommended that high-risk groups go to specialized hospitals for viral load testing, which can also be used as a confirmation standard for supplementary testing.

"21st Century": For HIV patients, who also benefit from the continuous introduction of new drugs, what kind of changes have there been in the treatment needs of patients?

Wang Hui: In the past, from the birth of "cocktail therapy" to "integrase inhibitors", the backbone drugs for the treatment of HIV are also constantly updated, and studies have found that a variety of drugs can be combined into one tablet as a compound single tablet preparation, which brings a good drug experience for patients, and the new compound single tablet reduces the impact of the drug on the body, and one pill can be taken daily. Therefore, the trend of antiviral treatment of AIDS has gone through a process from the original "no rule of law" to the later "curable" and now "aimed at improving the quality of life of patients".

Last year, UNAIDS proposed to achieve four 95 per cent: 95 per cent of HIV-infected people were detected, 95 per cent of HIV-infected people were treated, 95 per cent of HIV-infected people were treated to achieve complete control of the virus and were not contagious, and 95 per cent of the quality of life was significantly improved, including increasing social acceptance of him, eliminating discrimination and stigma, achieving equality for all, and ultimately achieving the goal of eliminating AIDS.

"21st Century": It is also based on the fact that HIV treatment drugs have more classifications, which is good for patients, but because of this, standardized medication and rational medication have also become more common problems, how do you think about this?

Wang Hui: In response to this problem, the AIDS Group of the Infectious Disease Branch of the Chinese Medical Association updated the diagnosis and treatment guidelines this year, that is, the "Chinese AIDS Diagnosis and Treatment Guidelines (2021 Edition)", which further updated the drug plan for POST-exposure prevention of AIDS, listed all the drugs that are now entering the country, and also pointed out which are first-line drugs and which are second-line drugs, in a certain situation we can only choose which drugs, and in another case, which drugs to choose, and regulate. At present, the guideline has just been published, and within the next year, there will be a nationwide doctor tour on the content of the guideline to standardize clinical use.

"21st Century": HIV antiviral treatment has entered the troika era of "free + medical insurance + self-payment", what is the difference between the efficacy of free, medical insurance and self-funded drugs?

Wang Hui: We have entered the "troika" stage, which refers to the stage of free medicine + self-funded medicine + medical insurance medicine, and the three drugs exist at the same time. These three types of adaptive groups have corresponding three treatment schemes, one is that people who choose medical insurance for medical treatment can choose drugs in the medical insurance catalog for treatment; the second is medical insurance + self-payment to purchase international new drugs for optimal treatment; and the third is that people without medical insurance can choose free treatment. Each person can choose the treatment that suits them best according to their different situation.

In the "National Basic Medical Insurance, Work Injury Insurance and Maternity Insurance Drug Catalogue (2021)" (hereinafter referred to as the 2021 Edition of the National Medical Insurance Drug Catalogue) officially released by the National Medical Insurance Bureau on December 3, 2021, antiviral treatment drugs have once again attracted much attention and become one of the focuses of the national medical insurance negotiations, and Gilead's two HIV treatment drugs have been included in the new version of the national medical insurance drug list, including the successful renewal of the medical insurance of Jiefukang ® (Piccolon tablets) and the successful renewal of the medical insurance of Bitowe ® (Bicken propylene tablets) It was also included in the new version of the national medical insurance drug list through this medical insurance negotiation. The bikleenpronol tablets (Pitivine) into the new version of the medical insurance directory, for the country and patients are a gospel, it is the first choice of first-line drugs identified by major international guidelines, there are three main advantages: one is fast virus reduction; second, the tablets are small, convenient to take; third, the resistance barrier is very high. I think that for a long time to come, there may be a phenomenon of patients competing for it.

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