Wit Ferdinand W.N.M., Reiss Peter
*International Antiviral Therapy Evaluation Center, Academic Medical Center, Room T0-120, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Curr Infect Dis Rep. 2003 Aug;5(4):349-357. doi: 10.1007/s11908-003-0013-y.
Although antiretroviral combination therapy has greatly improved the life expectancy of HIV-infected individuals, its use is hampered by considerable toxicity, the need for life-long near-perfect adherence to strict dosing regimens in order to avoid the emergence of drug resistance, and high cost. In this paper we review current understanding of when to best initiate antiretroviral therapy and what regimen to start with. The limitations of antiretroviral combination therapy are increasingly clear, and this has led to the current tendency to delay the initiation of therapy until CD4 cell counts have consistently dropped toward the 200 cells/mm(3 )mark, or until plasma HIV-1 RNA has increased to above 100,000 copies/mL. The need for optimal adherence also implies a "readiness" on the part of the patient to start treatment. Once the decision to commence therapy has been reached, what particular combinations of drugs to start with increasingly demands an individualized approach.
尽管抗逆转录病毒联合疗法极大地提高了HIV感染者的预期寿命，但其应用受到相当大的毒性、为避免耐药性出现而需要终身近乎完美地严格遵守给药方案以及成本高昂等因素的阻碍。在本文中，我们综述了目前对于何时最佳启动抗逆转录病毒治疗以及开始使用何种治疗方案的理解。抗逆转录病毒联合疗法的局限性日益明显，这导致了目前倾向于将治疗启动推迟到CD4细胞计数持续下降至200个细胞/立方毫米水平，或直到血浆HIV-1 RNA增加到高于100,000拷贝/毫升。最佳依从性的需求也意味着患者方面要有“准备好”开始治疗的意愿。一旦做出开始治疗的决定，开始使用哪些特定的药物组合越来越需要个体化方法。
