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目的评价CD4+T淋巴细胞(简称CD4细胞)计数与艾滋病病毒(HIV)病毒载量检测,对于HIV检测与病情诊断和治疗监测的经济性。方法设定检索时间与检索关键词,查阅中英文文献,比较两种检测技术的经济性,并分析其影响因素。结果相比仅依靠CD4细胞计数指导治疗,病毒载量检测指示的抗病毒治疗(ART)能够带来更好的治疗效果和健康结果,但是成本较高。在社会经济发展程度不高的地区,尚没有绝对的证据证明病毒载量检测较CD4细胞计数检测的经济性;而在经济较发达地区,病毒载量检测技术显示出更好的经济性;两种技术共用时,较CD4细胞计数单独使用时往往不具有经济性;仅在南非等经济较发达地区,合并使用两种检测技术更具备成本效果。ICER阈值、具体的检测方案、包含的成本范围以及考虑的健康收益范围,通常是影响经济性评价的重要因素。结论在资源限制的欠发达地区,CD4细胞计数显示出较好的经济性,应优先使用;在经济发展水平较好的地区,可尝试发展和使用病毒载量检测技术,或联合CD4细胞计数共同使用以指导ART。
Objective To evaluate the CD4 + T lymphocyte count (CD4) count and HIV viral load test for the economy of HIV testing and disease diagnosis and treatment monitoring. Methods to set the retrieval time and retrieval keywords, access to Chinese and English literature, compare the economy of the two detection techniques, and analyze the influencing factors. Results Anti-viral therapy (ART) indicated by viral load test leads to better therapeutic and health outcomes than direct CD4 cell count-directed therapy, but at a higher cost. In areas where socio-economic development is not high, there is still no absolute evidence that the detection of viral load is more economical than the detection of CD4 count; in the more economically developed areas, viral load detection technology shows better economy; two It is often not economical when compared to CD4 cell counts when used alone. In South Africa and other economically developed regions, it is more cost-effective to use both technologies together. The ICER threshold, the specific test protocol, the range of costs involved, and the range of health benefits under consideration are often important factors that influence economic evaluation. Conclusions CD4 cell counts in economically underdeveloped areas show good economy and should be used preferentially. In regions with good economic development, viral load testing may be developed and used, or in combination with CD4 cell count Used to guide ART.