Gallant Joel E
Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Curr HIV/AIDS Rep. 2005 Jun;2(2):83-9. doi: 10.1007/s11904-005-0023-5.
Failure of antiretroviral therapy can occur for a variety of reasons, but is often caused by or accompanied by drug resistance, which increases with continued time on nonsuppressive, failing regimens. Response to early virologic failure on an initial regimen may be associated with minimal or no resistance and can sometimes be managed simply by reinforcing adherence or by intensifying therapy. Resistance testing is an important tool for managing patients who are failing therapy; it should be used in most cases to guide selection of the next regimen. For patients with extensive treatment experience and drug resistance, there are a variety of approaches that have been suggested when fully suppressive options are not available. Clinicians caring for such patients must balance the benefit of slower progression associated with continued therapy against the risk of increasing drug resistance and loss of future treatment options.
抗逆转录病毒疗法失败可能有多种原因，但通常是由耐药性引起或伴有耐药性，随着在无抑制作用、失败的治疗方案上持续用药时间的延长，耐药性会增加。对初始治疗方案早期病毒学失败的反应可能与最小耐药或无耐药相关，有时只需加强依从性或强化治疗即可处理。耐药性检测是管理治疗失败患者的重要工具；在大多数情况下应使用该检测来指导下一治疗方案的选择。对于有广泛治疗经验和耐药性的患者，当没有完全抑制性的治疗选择时，已提出多种方法。治疗这类患者的临床医生必须在持续治疗带来的疾病进展缓慢的益处与耐药性增加和未来治疗选择丧失的风险之间取得平衡。
