摘要目的 评价高危人群中暴露前用药(PrEP)预防HIV感染的效果.方法 以preexposure prophylaxis、HIV、AIDS、high risk populations、relative risk、reduction为关键词,通过计算机检索PubMed、EMbase、Ovid、Web of Science、Science Direct、万方和清华同方数据库及相关网站,检索时间截至2012年6月,纳入关于高危人群在暴露前或暴露期间口服或局部使用单一或复方抗逆转录病毒药物(ARVs)预防HIV感染的临床随机对照试验(RCT)的文献.采用Stata 10.0软件进行Meta分析,对所纳入的研究进行一致性检验后计算合并RR值及其95％ CI值,并进行偏倚评估.结果 最终有5篇RCT纳入分析,共10 271名具有HIV高感染风险的阴性个体,其中试验组5929名,116例感染HIV,感染率为1.96％；对照组4342名,201例感染HIV,感染率为4.63％.Meta分析结果显示,PrEP预防HIV感染的合并效应量RR=0.49(95％ CI:0.39 ～0.61),P＜0.05,表明暴露前用药人群感染HIV的危险性是暴露前未用药人群的0.49倍.发表性偏倚分析结果显示,漏斗图对称,失安全系数为825.结论 PrEP是一种可降低高危人群HIV感染的安全有效的新方法.

abstractsObjective To evaluate the effect on pre-exposure prophylaxis (PrEP) to prevent HIV infection in high risk populations.Methods A computerized literature searching had been carried out in PubMed,EMbase,Ovid,Web of Science,Science Direct,Wanfang,Tsinghua Tongfang database and related websites to collect relevant papers (from establishment to June 2012) with the key words of pre-exposure prophylaxis,HIV,AIDS,high risk populations,relative risk,reduction.All randomized controlled trials (RCT)papers about using single or compound antiretroviral drugs(ARVs) orally or topically before HIV exposure or during HIV exposure in high risk populations were enrolled.Meta-analysis was conducted using Stata 10.0 to calculate the pooled RR value (95％ CI).Consistency test was performed and publication bias was evaluated.Results Finally 5 RCT papers were enrolled,including 10 271 persons who were at high risk of HIV infection.The number of the experimental group was 5929,among which 116 (1.96％) became infected.The number of the control group was 4342,among which 201 (4.63％) became infected.Metaanalysis showed that the pooled relative risk (RR) and 95 ％ CI was 0.49 (0.39-0.61),P ＜ 0.05,indicating that the persons in experimental group had a 0.49 times lower risk of HIV infected,as compared with the control group.Publication bias analysis revealed a symmetry funnel plot.The fail-safe number was 825.Conclusion PrEP was an effective and safe protection measure to reduce HIV infection in high risk populations.