Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA Panel.
Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA Panel.
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DOI：
10.1001/jama.2016.8900
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发表时间：
2016-07-12
影响因子：
120.7
通讯作者：
Volberding, Paul A.
中科院分区：
文献类型：
--
作者：
Gunthard, Huldrych F.;Saag, Michael S.;Benson, Constance A.;del Rio, Carlos;Eron, Joseph J.;Gallant, Joel E.;Hoy, Jennifer F.;Mugavero, Michael J.;Sax, Paul E.;Thompson, Melanie A.;Gandhi, Rajesh T.;Landovitz, Raphael J.;Smith, Davey M.;Jacobsen, Donna M.;Volberding, Paul A.
新的数据和治疗方案需要更新关于使用抗逆转录病毒药物（ARV）治疗或预防成人艾滋病毒感染的建议。为已确诊 HIV 感染的成人（年龄≥18 岁）使用抗逆转录病毒治疗提供最新建议，包括何时开始治疗、初始治疗方案和改变治疗方案，以及在高危人群中使用抗逆转录病毒药物预防 HIV 的建议，包括暴露前和暴露后预防。美国国际抗病毒协会召集的艾滋病毒研究和患者护理专家小组审查了自 2014 年报告以来在同行评审期刊上发表的数据、监管机构提交的数据或在同行评审科学会议上作为会议摘要提交的数据，以寻找可能改变之前建议或其评级的新数据或证据。截至 2016 年 4 月，我们在 PubMed 和 EMBASE 数据库中进行了全面的文献检索。建议是一致提出的，每项建议均根据证据的强度和质量进行评级。较新的数据支持广泛接受的建议，即无论 CD4 细胞计数如何，所有可检测到病毒血症的 HIV 感染者都应开始抗逆转录病毒治疗。对于大多数患者，推荐的最佳初始治疗方案是 2 种核苷逆转录酶抑制剂 (NRTI) 加一种整合酶链转移抑制剂 (InSTI)。其他有效的治疗方案包括非核苷类逆转录酶抑制剂或使用 2 种 NRTI 的加强型蛋白酶抑制剂。提供了针对特殊人群以及机会性感染和伴随病症的建议。转换治疗的原因包括方便、耐受性、简化、预期潜在的新药物相互作用、怀孕或计划怀孕、消除食物限制、病毒学失败或药物毒性。建议在治疗前进行实验室评估，并在治疗期间进行监测，以评估反应、不良反应和依从性。建议采取一些方法来改善护理的联系和保留。建议每日使用富马酸替诺福韦二吡呋酯/恩曲他滨作为暴露前预防，以预防高危人群感染 HIV。如有指征，应在暴露后尽快开始暴露后预防。抗逆转录病毒药物仍然是艾滋病毒治疗和预防的基石。所有可检测到血浆病毒的 HIV 感染者都应接受推荐的初始治疗方案，包括一种 InSTI 加 2 种 NRTI。暴露前预防应被视为高危人群艾滋病毒预防策略的一部分。如果有效使用，目前可用的抗逆转录病毒药物可以维持艾滋病毒抑制并预防新的艾滋病毒感染。通过这些治疗方案，接受护理的艾滋病毒感染成人的存活率可以接近未感染成人的存活率。
New data and therapeutic options warrant updated recommendations for the use of antiretroviral drugs (ARVs) to treat or to prevent HIV infection in adults. To provide updated recommendations for the use of antiretroviral therapy in adults (aged ≥18 years) with established HIV infection, including when to start treatment, initial regimens, and changing regimens, along with recommendations for using ARVs for preventing HIV among those at risk, including preexposure and postexposure prophylaxis. A panel of experts in HIV research and patient care convened by the International Antiviral Society-USA reviewed data published in peer-reviewed journals, presented by regulatory agencies, or presented as conference abstracts at peer-reviewed scientific conferences since the 2014 report, for new data or evidence that would change previous recommendations or their ratings. Comprehensive literature searches were conducted in the PubMed and EMBASE databases through April 2016. Recommendations were by consensus, and each recommendation was rated by strength and quality of the evidence. Newer data support the widely accepted recommendation that antiretroviral therapy should be started in all individuals with HIV infection with detectable viremia regardless of CD4 cell count. Recommended optimal initial regimens for most patients are 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (InSTI). Other effective regimens include nonnucleoside reverse transcriptase inhibitors or boosted protease inhibitors with 2 NRTIs. Recommendations for special populations and in the settings of opportunistic infections and concomitant conditions are provided. Reasons for switching therapy include convenience, tolerability, simplification, anticipation of potential new drug interactions, pregnancy or plans for pregnancy, elimination of food restrictions, virologic failure, or drug toxicities. Laboratory assessments are recommended before treatment, and monitoring during treatment is recommended to assess response, adverse effects, and adherence. Approaches are recommended to improve linkage to and retention in care are provided. Daily tenofovir disoproxil fumarate/emtricitabine is recommended for use as preexposure prophylaxis to prevent HIV infection in persons at high risk. When indicated, postexposure prophylaxis should be started as soon as possible after exposure. Antiretroviral agents remain the cornerstone of HIV treatment and prevention. All HIV-infected individuals with detectable plasma virus should receive treatment with recommended initial regimens consisting of an InSTI plus 2 NRTIs. Preexposure prophylaxis should be considered as part of an HIV prevention strategy for at-risk individuals. When used effectively, currently available ARVs can sustain HIV suppression and can prevent new HIV infection. With these treatment regimens, survival rates among HIV-infected adults who are retained in care can approach those of uninfected adults.
影响因子：
3.7
作者：
Ananworanich, Jintanat;Schuetz, Alexandra;Kim, Jerome H.
通讯作者：
Kim, Jerome H.