Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2018 Recommendations of the International Antiviral Society-USA Panel.
Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2018 Recommendations of the International Antiviral Society-USA Panel.
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DOI：
10.1001/jama.2018.8431
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发表时间：
2018-07-24
期刊：
影响因子：
--
通讯作者：
Volberding PA
中科院分区：
文献类型：
--
作者：
Saag MS;Benson CA;Gandhi RT;Hoy JF;Landovitz RJ;Mugavero MJ;Sax PE;Smith DM;Thompson MA;Buchbinder SP;Del Rio C;Eron JJ Jr;Fätkenheuer G;Günthard HF;Molina JM;Jacobsen DM;Volberding PA
抗逆转录病毒治疗（ART）是预防和管理艾滋病毒感染的基石。评估新数据和治疗方法，并将这些信息纳入更新的建议中，以启动治疗、监测开始治疗的个体、改变治疗方案以及预防高危个体的 HIV 感染。自国际抗病毒协会 - 美国 2016 年建议以来通过每月 PubMed 和 EMBASE 文献检索收集的新证据，截至 2018 年 4 月；在同行评审的科学会议上提出的数据。由艾滋病毒研究和患者护理专家组成的志愿者小组考虑了这些数据并更新了之前的建议。建议几乎所有 HIV 感染者在 HIV 诊断后尽快接受 ART。如果临床上合适，立即启动（例如快速启动）需要足够的人员配备、专业服务和仔细选择药物治疗。通常建议初始治疗使用整合酶链转移抑制剂 (InSTI) 加 2 种核苷逆转录酶抑制剂 (NRTI)，并根据患者的独特情况（例如伴随疾病和状况、妊娠可能性、费用）指导治疗选择。建议在 ART 之前和期间的特定时间点进行 CD4 细胞计数、HIV RNA 水平、基因型以及其他一般健康状况和合并感染的实验室检测。如果需要改变治疗方案，应首先评估治疗史、耐受性、依从性和耐药史；建议新方案使用 2 或 3 种活性药物。建议任何曾经有过性行为的人至少进行一次艾滋病毒检测，并且建议对有持续感染风险的个人进行更多次检测。建议对有艾滋病毒风险的个体使用富马酸替诺福韦二吡呋酯/恩曲他滨进行暴露前预防并进行适当监测。抗逆转录病毒药物预防和治疗艾滋病毒的进展继续改善有艾滋病毒风险和感染者的临床管理和结果。
Antiretroviral therapy (ART) is the cornerstone of prevention and management of HIV infection. To evaluate new data and treatments and incorporate this information into updated recommendations for initiating therapy, monitoring individuals starting therapy, changing regimens, and preventing HIV infection for individuals at risk. New evidence collected since the International Antiviral Society–USA 2016 recommendations via monthly PubMed and EMBASE literature searches up to April 2018; data presented at peer-reviewed scientific conferences. A volunteer panel of experts in HIV research and patient care considered these data and updated previous recommendations. ART is recommended for virtually all HIV-infected individuals, as soon as possible after HIV diagnosis. Immediate initiation (eg, rapid start), if clinically appropriate, requires adequate staffing, specialized services, and careful selection of medical therapy. An integrase strand transfer inhibitor (InSTI) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) is generally recommended for initial therapy, with unique patient circumstances (eg, concomitant diseases and conditions, potential for pregnancy, cost) guiding the treatment choice. CD4 cell count, HIV RNA level, genotype, and other laboratory tests for general health and co-infections are recommended at specified points before and during ART. If a regimen switch is indicated, treatment history, tolerability, adherence, and drug resistance history should first be assessed; 2 or 3 active drugs are recommended for a new regimen. HIV testing is recommended at least once for anyone who has ever been sexually active and more often for individuals at ongoing risk for infection. Preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and appropriate monitoring is recommended for individuals at risk for HIV. Advances in HIV prevention and treatment with antiretroviral drugs continue to improve clinical management and outcomes for individuals at risk for and living with HIV.
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影响因子：
4.1
作者：
Boesch AW;Alter G;Ackerman ME
通讯作者：
Ackerman ME
影响因子：
64.8
作者：
Caskey M;Klein F;Lorenzi JC;Seaman MS;West AP Jr;Buckley N;Kremer G;Nogueira L;Braunschweig M;Scheid JF;Horwitz JA;Shimeliovich I;Ben-Avraham S;Witmer-Pack M;Platten M;Lehmann C;Burke LA;Hawthorne T;Gorelick RJ;Walker BD;Keler T;Gulick RM;Fätkenheuer G;Schlesinger SJ;Nussenzweig MC
通讯作者：
Nussenzweig MC
影响因子：
11.8
作者：
Braun, Dominique L.;Kouyos, Roger D.;Guenthard, Huldrych F.
通讯作者：
Guenthard, Huldrych F.
影响因子：
5.2
作者：
Armenia, D.;Di Carlo, D.;Santoro, M. M.
通讯作者：
Santoro, M. M.
影响因子：
11.8
作者：
Brooks, Kristina M.;George, Jomy M.;Kumar, Parag
通讯作者：
Kumar, Parag