『保健医療科学』 2023 第72巻 第2号 p.90-97（2023年5月）
特集 : with コロナ時代の持続可能なエイズ対策—新規感染ゼロへの挑戦—＜総説＞
日本における HIV 診療の現状と課題
渡邊大
独立行政法人国立病院機構大阪医療センター臨床研究センターエイズ先端医療研究部
HIV therapy in Japan: Present status and challenges
WATANABE Dai
Department of Advanced Medicine for HIV Infection, Institute for Clinical Research,
National Hospital Organization Osaka National Hospital
抄録
HIV感染者の予後は大きく改善した．国内ではすでに抗HIV療法（antiretroviral therapy：ART）による高い治療成功率と治療継続率が得られている．この予後の改善には，日和見感染症の管理の向上，HIV診療に関する医療体制の整備や抗HIV治療ガイドラインの作成，研修会の実施や診療に関する情報発信などさまざまな要因が貢献してきた．さらに，強力で安全性の高い新規抗HIV薬の登場は，治療成功率を向上させただけではなく，新しい概念と治療のオプションをもたらした．有効なARTを継続し血中HIV-1-RNA量が検出限界未満の症例は，性交渉を通じてパートナーにHIVを感染させないことが明らかになった．これはUndetectable=Untransmittable（U=U）と呼ばれ，これまでの常識を刷新するメッセージである．また，2 剤療法や持効性注射剤といった新しい治療法も登場した．このような成功にも関わらず，HIV感染症の診断からARTの開始，ART後のプライマリケアまでのすべてステップが成功しているわけではない．本総説では，ARTについて最新の知見も踏まえつつ，HIV診療の現状と課題について概説する．
キーワード：抗HIV療法，Undetectable=Untransmittable，2 剤療法，持効性注射剤
Abstract
The prognosis for persons living with HIV has improved significantly. Antiretroviral therapy (ART) has previously been used successfully in Japan, with excellent treatment success rates and retention rates.Several factors have contributed to these improved prognoses, including improved management of opportunistic infections, establishment of health systems for HIV care, publication of the ART guidelines, provision of training, and dissemination of HIV care information. Furthermore, the emergence of new, effective, and safe anti-HIV drugs has not only improved treatment success rates, but has also resulted in the introduction of novel concepts and treatment options. It has been proven that patients on effective ART who have undetectable blood levels of HIV-1-RNA do not transmit HIV to their partners through sexual intercourse. This is known as Undetectable = Untransmittable (U=U), a concept that challenges commonly held beliefs about HIV infection. There has also been an emergence of innovative therapies, such as two-drug therapy and long-acting injectable regimens. However, not all steps from HIV infection diagnosis to primary care after ART introduction have been successful. This review summarizes the current status and challenges of HIV therapy in Japan, taking into account the latest findings on ART.
keywords: antiretroviral therapy, Undetectable=Untransmittable, two-drug regimens, long-acting injectable regimen