Strategies for long-term success in the treatment of HIV infection
Strategies for long-term success in the treatment of HIV infection
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DOI：
10.1001/jama.283.10.1329
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发表时间：
2000-03-08
影响因子：
120.7
通讯作者：
Gallant, JE
中科院分区：
文献类型：
--
作者：
Gallant, JE
高度活跃的抗逆转录病毒疗法彻底改变了人类免疫缺陷病毒（艾滋病毒）感染的治疗，这种疾病现在可以被视为一种慢性和可控制的疾病。然而，艾滋病毒感染与其他慢性疾病的不同之处在于，早期治疗决定可以不可逆转地改变患者对未来治疗的反应。尽管已批准的抗逆转录病毒药物数量众多，但由于3种药物类别之间的交叉耐药，对单个患者有效的顺序治疗方案数量受到严重限制。由于抗逆转录病毒疗法的复杂性，开处方的临床医生需要相当的专业知识。治疗应该推迟，直到患者被告知严格遵守治疗的重要性，并表现出开始治疗的意愿和动机。应选择患者能够耐受和坚持的药物方案，并在开始治疗前考虑耐药性的后果。当治疗失败时，后续治疗的时机和选择对于决定反应的程度和持久性至关重要。耐药试验可以帮助指导临床医生选择治疗方法。在接受过多种抗逆转录病毒药物治疗的患者中，可能无法实现显著的病毒抑制。治疗对这类患者可能仍然是有益的，但它应该是可耐受的，不应该增加对可能在不久的将来可用的药物的耐药性。耐药和治疗失败不是随机事件，而是临床医生和患者可以控制的因素的结果。对耐药患者的治疗具有挑战性；对付抵抗的最好办法是预防它。
Highly active antiretroviral therapy has revolutionized the treatment of human immunodeficiency virus (HIV) infection, which can now be viewed as a chronic and manageable disease. However, HIV infection differs from other chronic diseases in that early treatment decisions can irrevocably alter the patient's response to future therapy. Despite the large number of approved antiretroviral agents, the number of sequential treatment regimens that will be effective for an individual patient is sharply limited by cross-resistance within the 3 drug classes.Because of the complexity of antiretroviral therapy, clinicians prescribing it require considerable expertise. Treatment should be deferred until the patient has been educated about the importance of strict adherence and has demonstrated willingness and motivation to begin therapy. Drug regimens should be chosen that the patient can tolerate and adhere to, and the consequences of resistance should be considered before therapy is begun. When treatment fails, the timing and choice of subsequent therapy can be critical in determining the magnitude and durability of response. Resistance testing can help guide the clinician in the choice of therapy. In patients who have been treated with numerous antiretroviral agents, it may be impossible to achieve significant viral suppression. Therapy may still be beneficial for such patients, but it should be tolerable and should not increase resistance to drugs that may become available::in the near future.Drug resistance and-treatment failure are not random events, but are the result of factors over which clinicians and their patients have some control. The treatment of drug-resistant patients is challenging; the best way to deal with resistance is to prevent it.