Rubio Rafael, Berenguer Juan, Miró José M, Antela Antonio, Iribarren José Antonio, González Juan, Guerra Luis, Moreno Santiago, Arrizabalaga Julio, Clotet Buenaventura, Gatell José M, Laguna Fernando, Martínez Esteban, Parras Francisco, Santamaría Juan Miguel, Tuset Montserrat, Viciana Pompeyo
Hospital 12 Octubre, Madrid, Spain.
Enferm Infecc Microbiol Clin. 2002 Jun-Jul;20(6):244-303. doi: 10.1016/s0213-005x(02)72804-8.
To provide an update of recommendation on antiretroviral treatment (ART) in HIV-infected adults.Methods. These recommendations have been agreed by consensus by a committee of the spanish AIDS Study Group (GESIDA) and the National AIDS Plan. To do so, advances in the physiopathology of AIDS and the results on efficacy and safety in clinical trials, cohort and pharmacokinetics studies published in biomedical journals or presented at congresses in the last few years have been reviewed. Three levels of evidence have been defined according to the data source: randomized studies (level A), case-control or cohort studies (level B) and expert opinion (level C). Whether to recommend, consider, or not to recommend ART has been established for each situation.
Currently, ART with combinations of at least three drugs constitutes the treatment of choice in chronic HIV infection. In patients with symptomatic HIV infection, initiation of ART is recommended. In asymptomatic patients initiation of ART should be based on the CD41/mL lymphocyte count and on the plasma viral load (PVL): a) in patients with CD41 lymphocytes < 200 cells/mL, initiation of ART is recommended; b) in patients with CD41 lymphocytes between 200 and 300 cells/mL, initiation of ART should, in most cases, be recommended; however, it could be delayed when the CD41 lymphocyte count remains close to 350 cells/mL and the PVL is low, and c) in patients with CD41 lymphocytes > 350 cells/mL, initiation of ART can be delayed. The aim of ART is to achieve an undetectable PVL. Adherence to ART plays a role in the durability of the antiviral response. Because of the development of cross-resistance, the therapeutic options in treatment failure are limited. In these cases, genotypic analysis is useful. Toxicity limits ART. The criteria for ART in acute infection, pregnancy and postexposure prophylaxis and in the management of coinfection with HIV and hepatitis C and B virus are controversial.
The current approach to initiating ART is more conservative than in previous recommendations. In asymptomatic patients, the CD41 lymphocyte count is the most important reference factor for initiating ART. Because of the considerable number of drugs available, more sensitive monitoring methods (PVL) and the possibility of determining resistance, therapeutic strategies have become much more individualized.
提供关于HIV感染成人抗逆转录病毒治疗（ART）建议的最新信息。
这些建议已由西班牙艾滋病研究小组（GESIDA）和国家艾滋病计划委员会达成共识。为此，回顾了近年来发表在生物医学期刊或在大会上展示的艾滋病生理病理学进展以及临床试验、队列研究和药代动力学研究的疗效和安全性结果。根据数据来源定义了三个证据级别：随机研究（A级）、病例对照或队列研究（B级）和专家意见（C级）。针对每种情况确定了是否推荐、考虑或不推荐ART。
目前，至少三种药物联合的ART是慢性HIV感染的首选治疗方法。对于有症状的HIV感染患者，建议开始ART。对于无症状患者，ART的启动应基于CD4+ /mL淋巴细胞计数和血浆病毒载量（PVL）：a）CD4+淋巴细胞<200细胞/mL的患者，建议开始ART；b）CD4+淋巴细胞在200至300细胞/mL之间的患者，在大多数情况下应建议开始ART；然而，当CD4+淋巴细胞计数保持接近350细胞/mL且PVL较低时，可以延迟开始，c）CD4+淋巴细胞>350细胞/mL的患者，可以延迟开始ART。ART的目标是使PVL检测不到。坚持ART对抗病毒反应的持久性有作用。由于交叉耐药的发展，治疗失败时的治疗选择有限。在这些情况下，基因分析是有用的。毒性限制了ART。急性感染、妊娠和暴露后预防以及HIV与丙型和乙型肝炎病毒合并感染管理中的ART标准存在争议。
目前启动ART的方法比以前的建议更为保守。在无症状患者中，CD4+淋巴细胞计数是启动ART的最重要参考因素。由于有大量可用药物、更敏感的监测方法（PVL）以及确定耐药性的可能性，治疗策略变得更加个体化。
