Yeni Patrick G, Hammer Scott M, Carpenter Charles C J, Cooper David A, Fischl Margaret A, Gatell Jose M, Gazzard Brian G, Hirsch Martin S, Jacobsen Donna M, Katzenstein David A, Montaner Julio S G, Richman Douglas D, Saag Michael S, Schechter Mauro, Schooley Robert T, Thompson Melanie A, Vella Stefano, Volberding Paul A
Hôpital Bichat-Claude Bernard, Department of Infectious Diseases, 46 Rue Henri-Huchard, Paris, Cedex 18 France 75877.
JAMA. 2002 Jul 10;288(2):222-35. doi: 10.1001/jama.288.2.222.
New information warrants updated recommendations for the 4 central issues in antiretroviral therapy: when to start, what drugs to start with, when to change, and what to change to. These updated recommendations are intended to guide practicing physicians actively involved in human immunodeficiency virus (HIV)- and acquired immunodeficiency syndrome (AIDS)-related care.
In 1995, physicians with specific expertise in HIV-related basic science and clinical research, antiretroviral therapy, and HIV patient care were invited by the International AIDS Society-USA to serve on a volunteer panel. In 1999, others were invited to broaden international representation. The 17-member panel met regularly in closed meetings between its last report in 2000 and April 2002 to review current data. The effort was sponsored and funded by the International AIDS Society-USA, a not-for-profit physician education organization.
The full panel was convened in late 2000 and assigned 7 section committees. A section writer and 3 to 5 section committee members (each panel member served on numerous sections) identified relevant evidence and prepared draft recommendations. Basic science, clinical research, and epidemiologic data from the published literature and abstracts from recent (within 2 years) scientific conferences were considered by strength of evidence. Extrapolations from basic science data and expert opinion of the panel members were included as evidence. Draft sections were combined and circulated to the entire panel and discussed in a series of full-panel conference calls until consensus was reached. Final recommendations represent full consensus agreement of the panel.
Because of increased awareness of the activity and toxicity of current drugs, the threshold for initiation of therapy has shifted to a later time in the course of HIV disease. However, the optimal time to initiate therapy remains imprecisely defined. Availability of new drugs has broadened options for therapy initiation and management of treatment failure, which remains a difficult challenge.
新信息需要对抗逆转录病毒治疗中的4个核心问题给出更新的建议，即何时开始治疗、起始使用何种药物、何时更换药物以及更换为何种药物。这些更新的建议旨在指导积极参与人类免疫缺陷病毒（HIV）及获得性免疫缺陷综合征（AIDS）相关护理的执业医师。
1995年，美国国际艾滋病协会邀请在HIV相关基础科学、临床研究、抗逆转录病毒治疗及HIV患者护理方面具有专业特长的医师组成一个志愿者小组。1999年，邀请了其他人员以扩大国际代表性。这个由17名成员组成的小组在2000年的上一次报告至2002年4月期间定期举行闭门会议，以审查当前数据。这项工作由美国国际艾滋病协会赞助和资助，该协会是一个非营利性医师教育组织。
2000年末召集了整个小组，并指定了7个分组委员会。一名分组撰写人和3至5名分组委员会成员（每个小组成员参与多个分组）确定相关证据并起草建议。已发表文献中的基础科学、临床研究和流行病学数据以及近期（2年内）科学会议的摘要根据证据强度进行考量。基础科学数据的推断以及小组成员的专家意见也被纳入证据。各分组草案合并后分发给整个小组，并在一系列全体小组电话会议上进行讨论，直至达成共识。最终建议代表了小组的完全共识。
由于对现有药物活性和毒性的认识提高，治疗起始阈值已在HIV疾病进程中推迟。然而，起始治疗的最佳时间仍未明确界定。新药的可获得性拓宽了治疗起始和治疗失败管理的选择，但治疗失败仍然是一个艰巨的挑战。
