Changing antiretroviral therapy in the setting of virologic relapse: review of the current literature.
Changing antiretroviral therapy in the setting of virologic relapse: review of the current literature.
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DOI：
10.1007/s11904-006-0022-1
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发表时间：
2006-07-01
影响因子：
4.6
通讯作者：
Bartlett, John A
中科院分区：
文献类型：
--
作者：
Anderson, Albert M L;Bartlett, John A
在最初的病毒学抑制后，病毒学复发仍然是接受抗逆转录病毒治疗(ART)的患者的一个担忧。多种因素可能导致病毒学复发，包括不理想的依从性、耐药性和药代动力学问题。艾滋病毒治疗的主要指南一致认为，由于发现了耐药性，ART方案的改变表明复发，但指南对方案改变的时间并不完全清楚。当由于耐药性而复发时，患者可能会持续病毒血症，远远低于他们的设定值，稳定或增加CD4+计数，并在几年内保持临床健康。然而，推迟治疗方案的转换可能会导致耐药性的积累，从而影响未来的治疗反应。一般来说，对于一线或二线方案复发的患者，建议使用较低的切换阈值。
Virologic relapse after initial virologic suppression remains a concern for patients on antiretroviral therapy (ART). Multiple factors may contribute to virologic relapse, including suboptimal adherence, resistance, and pharmacokinetic issues. The major guidelines for HIV care are in agreement that ART regimen change is indicated in relapse because resistance is identified, but the guidelines are not completely clear on the timing of regimen change. When relapse occurs due to resistance, patients may continue with viremia well below their set points, stable or increasing CD4+ counts, and clinical health for several years. However, delaying a switch in the treatment regimen may lead to the accumulation of resistance which compromises future treatment response. In general, a lower switch threshold is recommended for patients during relapse on first or second line regimens.