Critical Care Pharmacology of Antiretroviral Therapy in Adults
Critical Care Pharmacology of Antiretroviral Therapy in Adults
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干草堆中的针：识别合并基因组数据中存在的个体
DOI：
10.1007/s13318-025-00934-7
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发表时间：
2025-02-12
影响因子：
2.400
通讯作者：
Christian Zanza
中科院分区：
文献类型：
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作者：
Luigi La Via;Andrea Marino;Giuseppe Cuttone;Giuseppe Nunnari;Cristian Deana;Manfredi Tesauro;Antonio Voza;Raymond Planinsic;Yaroslava Longhitano;Christian Zanza
由于HIV感染、危重病和药物管理之间复杂的相互作用，重症监护中抗逆转录病毒治疗（ART）的临床药理学提出了独特的挑战。这篇全面的综述研究了抗逆转录病毒药物在危重患者中的药代动力学和药效学考虑，其中吸收、分布、代谢和排泄的改变显著影响药物的有效性和安全性。危重病可通过各种机制显著改变药物药代动力学，包括胃肠动力受损、液体转移、低白蛋白血症、肝功能障碍和肾功能改变。这些变化，加上重症监护病房的多种药物环境中潜在的药物相互作用，需要仔细考虑给药策略和监测方法。该综述讨论了各种重症监护情况下的具体挑战，包括器官功能障碍患者、肾脏替代治疗期间以及脓毒症或急性呼吸窘迫综合征等特殊人群的ART管理。它还探讨了治疗药物监测在优化抗逆转录病毒治疗和管理重症监护环境中的药物毒性方面的作用。新兴的研究领域，包括长效制剂，纳米技术为基础的药物输送系统和个性化的医疗方法，讨论了潜在的未来方向，以改善ART管理的重症监护。该综述强调了多学科方法的重要性，包括重症监护医生，传染病专家和临床药师，以优化这一复杂患者人群的结局。这篇综述为临床医生提供了在危重患者中管理ART的实用指导，同时强调了需要进一步研究的领域，以增强我们对这一挑战性环境的理解并改善患者护理。
The clinical pharmacology of antiretroviral therapy (ART) in critical care presents unique challenges due to the complex interplay between HIV infection, critical illness, and drug management. This comprehensive review examines the pharmacokinetic and pharmacodynamic considerations of antiretroviral drugs in critically ill patients, where altered absorption, distribution, metabolism, and excretion significantly impact drug effectiveness and safety. Critical illness can substantially modify drug pharmacokinetics through various mechanisms, including impaired gastrointestinal motility, fluid shifts, hypoalbuminemia, hepatic dysfunction, and altered renal function. These changes, combined with potential drug–drug interactions in the polypharmacy environment of intensive care units, necessitate careful consideration of dosing strategies and monitoring approaches. The review addresses specific challenges in various critical care scenarios, including management of ART in patients with organ dysfunction, during renal replacement therapy, and in special populations such as those with sepsis or acute respiratory distress syndrome. It also explores the role of therapeutic drug monitoring in optimizing antiretroviral therapy and managing drug toxicities in critical care settings. Emerging areas of research, including long-acting formulations, nanotechnology-based drug delivery systems, and personalized medicine approaches, are discussed as potential future directions for improving ART management in critical care. The review emphasizes the importance of a multidisciplinary approach involving critical care physicians, infectious disease specialists, and clinical pharmacists to optimize outcomes in this complex patient population. This review provides clinicians with practical guidance for managing ART in critically ill patients while highlighting areas requiring further research to enhance our understanding and improve patient care in this challenging setting.