Toward a universal antiretroviral regimen: special considerations of pregnancy and breast feeding.
Toward a universal antiretroviral regimen: special considerations of pregnancy and breast feeding.
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DOI：
10.1097/coh.0000000000000386
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发表时间：
2017-07
影响因子：
4.1
通讯作者：
Abrams EJ
中科院分区：
文献类型：
--
作者：
Slogrove AL;Clayden P;Abrams EJ
随着优化的抗逆转录病毒治疗（ART）方案准备在低收入和中等收入国家（LMIC）推出，我们考虑了即将在全球市场推出的下一代一线和二线抗逆转录病毒治疗方案在妊娠和哺乳期间的剂量、疗效和安全性方面的现有证据。妊娠药代动力学方面的考虑包括：如果剂量为400mg/天，依非韦伦暴露可能不足，每天需要两次达那韦给药，缺乏与替诺福韦和多替格拉韦给药、安全性和有效性相关的数据。越来越多的证据表明，这与不良分娩结果有关，特别是在接受抗逆转录病毒治疗的妇女中，并且因药物和药物联合使用而具有不同的风险。正在进行或计划进行临床试验和研究，目的是确定几种新的抗逆转录病毒药物的剂量、安全性和有效性。为包括孕妇在内的低收入和中等收入国家所有艾滋病毒感染者提供普遍、高效和安全的抗逆转录病毒治疗方案，显然是保持母亲生命和健康并防止将艾滋病毒传染给其子女的最有益战略。必须确定使用下一代优化的抗逆转录病毒药物是否也会优化孕妇及其子女的健康结果。
As optimized antiretroviral therapy (ART) regimens are prepared for introduction in low and middle income countries (LMIC), we consider the current evidence related to dosing, efficacy and safety during pregnancy and breastfeeding of next generation first- and second-line ART regimens proposed for imminent introduction in the global marketplace. Pregnancy pharmacokinetic considerations include potentially insufficient efavirenz exposure if dosed at 400mg/day, the need for twice daily darunavir dosing and the paucity of data related to tenofovir alafenamide and dolutegravir dosing, safety and efficacy. Increasingly evidence suggests an association with adverse birth outcomes, particularly in women conceiving on ART, and with varying risk by drug and drug combination. Clinical trials and studies are in progress or planned that aim to determine dosing, safety and efficacy of several new antiretrovirals. Having a universal, highly potent and safe ART regimen for all individuals living with HIV in LMIC including pregnant women is clearly the most beneficial strategy to keep mothers alive and healthy and to prevent transmission of HIV to their children. It will have to be determined whether use of this next generation of optimized antiretrovirals will also optimize health outcomes of pregnant women and their children.