Jakob-Sölder B
Universitätsklinik für Kinder- und Jugendheilkunde, Innsbruck.
Wien Med Wochenschr. 1998;148(23-24):539-46.
Former antiretroviral treatment strategies in pediatric HIV-infection were based on the occurrence of clinical symptoms or loss of CD4-cells. Because of toxicity and dosing concerns HIV-infected children have often been denied new drugs routinely prescribed to HIV-infected adults. Over the last few years new insights into the pathogenesis of HIV disease, the availability of quantitative viral load measurements and the development of new antiretroviral agents have brought dramatic changes in our understanding of the disease and the role of antiretroviral treatment. Similar to adults it was also shown in children that potent combination regimens applied early in the course of HIV-infection can achieve long-term control of viral replication and thus preservation of immune function and reduction of disease progression. However, there are only poor clinical data regarding dosing, pharmacokinetics, and antiretroviral activity of new combination therapies in infants and young children, pediatric studies are urgently needed. Consensus has been growing that children must not be denied modern therapy because of the lack of pediatric clinical data, and recently treatment guidelines were developed by specialists in pediatric HIV-care which recommend early combination antiretroviral therapies in infants and young children. It is likely that recommendations will change as more data become available about the effects of different treatment regimens.
儿科HIV感染的既往抗逆转录病毒治疗策略是基于临床症状的出现或CD4细胞的减少。由于毒性和给药方面的顾虑，感染HIV的儿童常常无法获得常规开给感染HIV成人的新药。在过去几年里，对HIV疾病发病机制的新认识、病毒载量定量检测的可及性以及新型抗逆转录病毒药物的研发，使我们对该疾病以及抗逆转录病毒治疗的作用有了巨大改变。与成人一样，在儿童中也显示，在HIV感染病程早期应用强效联合治疗方案可实现病毒复制的长期控制，从而维持免疫功能并减少疾病进展。然而，关于婴幼儿新联合疗法的给药、药代动力学和抗逆转录病毒活性的临床数据很少，迫切需要开展儿科研究。越来越多的人达成共识，即儿童不应因缺乏儿科临床数据而被拒绝接受现代治疗，最近儿科HIV治疗专家制定了治疗指南，建议对婴幼儿尽早进行联合抗逆转录病毒治疗。随着更多关于不同治疗方案效果的数据出现，建议可能会发生变化。
