Gupta Ravindra Kumar, Pillay Deenan
Department of Infectious Diseases, John Radcliffe Hospital, Oxford, UK.
Int J Antimicrob Agents. 2007 May;29(5):510-7. doi: 10.1016/j.ijantimicag.2007.01.003. Epub 2007 Mar 7.
Rollout of antiretroviral therapy (ART) in resource-limited countries has been identified as a global public health priority. Human immunodeficiency virus (HIV) treatment in the industrialised world is routinely accompanied by regular virological monitoring. By contrast, the implementation of ART in resource-limited settings requires use of standard first- and second-line therapy. One major consequence is the likely emergence of high-level resistance during first-line therapy since most people will stay on a virologically failing regimen for longer periods, potentially compromising the efficacy of second-line therapy. The evidence regarding resistance to triple-drug ART relates to the time at which virological failure occurs in populations from developed countries, with little data from resource-poor contexts where monitoring strategies, HIV subtypes and drug combinations are likely to differ.
在资源有限的国家推广抗逆转录病毒疗法（ART）已被视为一项全球公共卫生重点工作。在工业化国家，人类免疫缺陷病毒（HIV）治疗通常伴有定期的病毒学监测。相比之下，在资源有限的环境中实施抗逆转录病毒疗法需要使用标准的一线和二线疗法。一个主要后果是在一线治疗期间可能会出现高水平耐药性，因为大多数人会在病毒学治疗失败的方案上停留更长时间，这可能会影响二线治疗的疗效。关于对三联药物抗逆转录病毒疗法耐药性的证据涉及发达国家人群中病毒学失败发生的时间，而来自资源匮乏地区的数据很少，因为这些地区的监测策略、HIV亚型和药物组合可能不同。
