Shet Anita, Markowitz Martin
Aaron Diamond AIDS Research Center, Rockefeller University, 455 First Avenue, New York, NY 10016, USA.
Curr Opin Investig Drugs. 2006 Aug;7(8):709-20.
The increasing prevalence of transmitted drug-resistant HIV-1 has highlighted the challenging issue of the optimal management of antiretroviral-naïve, newly infected patients with multidrug-resistant HIV-1. This review discusses current trends in the evolution and transmission of HIV-1 with reduced susceptibility to multiple antiretroviral agents. In most cases, clinical strategies for the management of such patients with stable virological and immunological parameters involve deferment of therapy until clinically indicated. When a decision is made to initiate therapy, the process of selecting a regimen should consider baseline viral genotype and phenotype results, as well as the inclusion of novel agents with diverse mechanisms of action, in order to achieve a more complete suppression of viral replication. A summary of established and investigational antiretroviral agents is presented in this review, together with novel therapeutic approaches to decrease the burden of viral replication and maintain immunological status in cases of transmitted multidrug-resistant HIV-1 infection.
传播性耐药HIV-1的患病率不断上升，凸显了对抗逆转录病毒治疗初治、新感染的多重耐药HIV-1患者进行最佳管理这一具有挑战性的问题。本综述讨论了对多种抗逆转录病毒药物敏感性降低的HIV-1的演变和传播的当前趋势。在大多数情况下，对这类病毒学和免疫学参数稳定的患者进行管理的临床策略包括推迟治疗，直到有临床指征。当决定开始治疗时，选择治疗方案的过程应考虑基线病毒基因型和表型结果，以及纳入具有不同作用机制的新型药物，以更全面地抑制病毒复制。本综述介绍了已确立的和正在研究的抗逆转录病毒药物的总结，以及在传播性多重耐药HIV-1感染病例中减少病毒复制负担和维持免疫状态的新型治疗方法。
