Serious Non-AIDS Events: Therapeutic Targets of Immune Activation and Chronic Inflammation in HIV Infection.
Serious Non-AIDS Events: Therapeutic Targets of Immune Activation and Chronic Inflammation in HIV Infection.
复制标题
DOI：
10.1007/s40265-016-0546-7
复制
发表时间：
2016-04
期刊：
影响因子：
11.5
通讯作者：
Sereti I
中科院分区：
文献类型：
--
作者：
Hsu DC;Sereti I
在ART时代，严重非艾滋病事件（SNAE）已成为HIV感染者发病和死亡的主要原因。早期开始抗逆转录病毒治疗有最强有力的证据表明可以减少SNAE和死亡率。免疫激活、炎症和凝血病的生物标志物尽管受到病毒学抑制，但并未完全正常化，持续免疫激活是SNAE的重要促成因素。已经研究了许多旨在减少持续性免疫激活的策略，包括ART强化以减少残留病毒血症;治疗合并感染以减少慢性抗原刺激;使用抗炎剂，减少微生物易位以及通过细胞因子给药和减少淋巴组织纤维化来改善免疫恢复的干预措施。迄今为止，除了治疗B和C型肝炎合并感染和减少心血管危险因素外，还没有确凿的证据表明哪些策略会给已经接受ART并抑制病毒的患者带来临床益处。他汀类药物的使用似乎显示出早期的希望，更大规模的临床试验正在进行中，以确认其疗效。因此，在现阶段，对艾滋病毒感染患者的临床护理应侧重于早期诊断和及时开始抗逆转录病毒治疗，治疗活动性合并感染，并积极管理合并症，直到获得进一步数据。
In the ART era, serious non-AIDS events (SNAEs) have become the major causes of morbidity and mortality in HIV-infected persons. Early ART initiation has the strongest evidence for reducing SNAEs and mortality. Biomarkers of immune activation, inflammation and coagulopathy do not fully normalize despite virologic suppression and persistent immune activation is an important contributor to SNAEs. A number of strategies aimed to reduce persistent immune activation including ART intensification to reduce residual viremia; treatment of co-infections to reduce chronic antigen stimulation; the use of anti-inflammatory agents, reducing microbial translocation as well as interventions to improve immune recovery through cytokine administration and reducing lymphoid tissue fibrosis have been investigated. To date, there is little conclusive evidence on which strategies beyond treatment of hepatitis B and C co-infections and reducing cardiovascular risk factors will result in clinical benefits in patients already on ART with viral suppression. The use of statins seems to show early promise and larger clinical trials are underway to confirm their efficacy. At this stage, clinical care of HIV-infected patients should therefore focus on early diagnosis and prompt ART initiation, treatment of active co-infections and the aggressive management of co-morbidities until further data are available.
登录
查看更多内容
影响因子：
11.8
作者：
Althoff, Keri N.;McGinnis, Kathleen A.;Justice, Amy C.
通讯作者：
Justice, Amy C.
影响因子：
3.9
作者：
Appay, Victor;Almeida, Jorge R.;Papagno, Laura
通讯作者：
Papagno, Laura
影响因子：
82.9
作者：
通讯作者：
--
影响因子：
11.8
作者：
Armah, Kaku A.;McGinnis, Kathleen;Freiberg, Matthew
通讯作者：
Freiberg, Matthew
影响因子：
5.4
作者：
Baker JV;Brummel-Ziedins K;Neuhaus J;Duprez D;Cummins N;Dalmau D;DeHovitz J;Lehmann C;Sullivan A;Woolley I;Kuller L;Neaton JD;Tracy RP;INSIGHT SMART Study Team
通讯作者：
INSIGHT SMART Study Team