Gilliam Bruce L, Redfield Robert R
Division of Clinical Care and Research, Institute of Human Virology, University of Maryland, Baltimore, MD 21201, USA.
Cell Res. 2005 Nov-Dec;15(11-12):895-902. doi: 10.1038/sj.cr.7290365.
China has recognized the threat of HIV to its population and responded with a national antiretroviral treatment (ART) program. However, high ART failure rates and the spread of resistance within populations are important realities to consider when developing and managing ART programs in China and worldwide. Concepts which will define treatment success and local and national programmatic goals are 1) access to ART, 2) durability of ART at the patient level, 3) scalability of treatment modalities, and the 4) sustainability of the program at the community or national level. In the face of limited resources, China must also consider when to start ARV therapy, which agents to use, when to switch them, and how to treat highly experienced patients with drug resistance. The optimal ARV regimen to start with is changing frequently with the introduction of new agents and the presentation of new data. Currently, a regimen including tenofovir, emtricitabine or lamivudine and a nonnucleoside reverse transcriptase inhibitor appears to have optimal characteristics to treat HIV/AIDS in China. However, critical to all of these choices is the evaluation of programs implemented to insure wide scale success. China has wisely begun this process of evaluating the performance of local programs through systematic monitoring and evaluation of treatment outcomes. This will allow regimens and programs that work to be expanded, and programs with high failure rates to be eliminated. In the end, evidence based data supporting treatment strategies will allow China to successfully confront its AIDS epidemic early and prevent its tragic consequences.
中国已经认识到艾滋病毒对其人口构成的威胁，并通过一项全国抗逆转录病毒治疗（ART）计划做出了应对。然而，在制定和管理中国乃至全球的ART计划时，高ART失败率以及耐药性在人群中的传播是需要考虑的重要现实情况。定义治疗成功以及地方和国家计划目标的概念包括：1）获得ART治疗的机会；2）患者层面ART治疗的持久性；3）治疗方式的可扩展性；4）社区或国家层面计划的可持续性。面对资源有限的情况，中国还必须考虑何时开始抗逆转录病毒治疗、使用哪些药物、何时换药，以及如何治疗有高度耐药经验的患者。随着新药物的引入和新数据的呈现，初始的最佳抗逆转录病毒治疗方案也在频繁变化。目前，一种包含替诺福韦、恩曲他滨或拉米夫定以及一种非核苷类逆转录酶抑制剂的治疗方案，似乎在中国治疗艾滋病毒/艾滋病方面具有最佳特性。然而，所有这些选择的关键在于对已实施计划的评估，以确保广泛的成功。中国明智地通过对治疗结果进行系统监测和评估，开始了评估地方计划绩效的这一进程。这将使有效的治疗方案得以扩大，而失败率高的方案得以淘汰。最终，支持治疗策略的循证数据将使中国能够尽早成功应对艾滋病疫情，并防止其带来的悲惨后果。
