Hit HIV-1 hard, but only when necessary
Hit HIV-1 hard, but only when necessary
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DOI：
10.1016/s0140-6736(00)02388-6
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发表时间：
2000-06-17
期刊：
影响因子：
168.9
通讯作者：
Carpenter, CCJ
中科院分区：
文献类型：
--
作者：
Harrington, M;Carpenter, CCJ
随机对照试验数据显示，联合抗逆转录病毒治疗艾滋病毒-1感染的患者受益于CD_4细胞数低于350个/亩的患者。基于目前已知的风险和益处，我们认为，如果仔细监测CD_4细胞计数和病毒载量，并在CD_4细胞数降至350个/亩以下时通常开始高效抗逆转录病毒治疗，则可以极大地延缓或预防临床相关免疫系统的损害以及向艾滋病和死亡的进展。这种做法是由艾滋病毒-1感染的三个非典型传染病特征决定的：没有可用的方案可以根除艾滋病毒-1；所有目前有效的方案都可能造成不良的、有时危及生命的毒性影响；除非严格遵守方案，否则可能会产生多药耐药性，限制未来的治疗选择。如果过早开始治疗，所用药物的累积副作用和多药耐药性的发展可能会超过延长生命的净效益。如果治疗开始得太晚，疾病进展和死亡率的增加将超过不良事件的风险。一位患者活动家(MH)和一位临床医生(CCJC)讨论了证明这种平衡方法的合理性的数据以及随机对照试验的可行性，以提供关于何时开始治疗的更明确的答案。
Randomised, controlled trial data show that combination antiretroviral therapy for HIV-1 infection benefits people with CD4-cell counts less than 350 cells/mu L. Based on currently known risks and benefits, we believe that if CD4-cell counts and viral load are monitored carefully, and highly active antiretroviral therapy (HAART) is started commonly when the CD4-cell count drops below 350 cells/mu L, then clinically relevant immune-system damage and progression to AIDS and death can be greatly delayed or prevented. This approach is dictated by three features of HIV-1 infection that are not typical of infectious diseases: no available regimen can eradicate HIV-1; all currently effective regimens may cause undesirable, sometimes life-threatening, toxic effects; and, unless regimens are strictly adhered to, multidrug resistance can develop, limiting future treatment options. If therapy is started too early, cumulative side-effects of the drugs used and the development of multidrug resistance may outweigh the net benefits of the lengthening of life. If therapy is started too late, increases in disease progression and mortality outweigh the risk of adverse events. A patients' activist (MH) and a clinician (CCJC) discuss data that justify this balanced approach and the feasibility of randomised controlled trials to provide clearer answers about when to start treatment.