The fusion inhibitor enfuvirtide in recent antiretroviral strategies
The fusion inhibitor enfuvirtide in recent antiretroviral strategies
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DOI：
10.1097/coh.0b013e32832498d8
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发表时间：
2009-03-01
影响因子：
4.1
通讯作者：
Reynes, Jacques
中科院分区：
文献类型：
--
作者：
Makinson, Alain;Reynes, Jacques
综述的目的是讨论有关恩福韦在不同抗逆转录病毒药物组合中使用的最新药理学、病毒学和临床数据。最近的发现最近在有多种药物经验的患者中随机进行的近期试验表明，与恩福韦德联合使用的抗逆转录病毒对新的抗逆转录病毒化合物有良好的病毒学反应，包括达鲁那韦、依特拉韦林、雷替格列韦、维利韦罗和马拉韦罗。试验证实，尽管注射部位有中度反应或疼痛，且缺乏显著的相互作用，但仍具有长期安全性。初步数据表明，从恩福韦改为雷替格列韦是有效的，并且在预防母婴传播时使用恩福韦具有良好的耐受性。在抗逆转录病毒初学者或有经验的人群中，在强化策略中应用恩富韦肽可能会加速病毒学下降。脊髓液浓度和脐带通道可以忽略不计。尽管有注射部位的反应和每天两次皮下注射，但联合应用恩福韦肽的病毒学反应的持久性已得到证实。在经历过多种药物的人群中，恩福韦肽应该与至少一种其他完全有效的药物一起使用，进行优化的背景治疗，可能的例外是进入抑制剂，这可能会从添加第三种活性药物中进一步受益。抗逆转录病毒药物组合中有关恩福韦肽的数据显示，病毒载量加速下降，而且在不修改优化的背景疗法的情况下，有可能从恩福韦德切换到雷替格列韦。
Purpose of reviewThe purpose of this review is to discuss recent pharmacological, virological, and clinical data that concern enfuvirtide usage in different antiretroviral combinations.Recent findingsRandomized, recent trials in multidrug-experienced patients suggest that antiretroviral combinations with enfuvirtide have excellent virological responses with new antiretroviral compounds, including darunavir, etravirine, raltegravir, vicriviroc, and maraviroc. Trials confirm long-term safety, in spite of moderate injection-site reactions or pain, and lack of significant interactions. Preliminary data suggest that switching from enfuvirtide to raltegravir is effective and using enfuvirtide in prophylaxis of mother-to-child transmission is well tolerated. To administer enfuvirtide in an intensification strategy in antiretroviral-naive or experienced populations may accelerate virological decline.SummaryDosage adaptations to renal insufficiency are not necessary with enfuvirtide. Spinal fluid concentrations and ombilic cord passage are negligible. Durability of virological responses with enfuvirtide in combinations has been confirmed, in spite of injection-site reactions and twice daily subcutaneous administration. Enfuvirtide should be used with at least one other fully active drug in optimized background therapy in multidrug-experienced populations, a possible exception being with entry inhibitors, which may further benefit from the addition of a third active drug. Data concerning enfuvirtide in antiretroviral combinations show accelerated viral load decline, and the possibility of switching from enfuvirtide to raltegravir without modification of optimized background therapy.