Arastéh Keikawus, Stocker Hartmut
Vivantes Auguste-Viktoria-Klinikum, Klinik für Innere Medizin, Infektiologie/Gastroenterologie, Rubensstr. 125, 12157 Berlin, Germany.
Eur J Med Res. 2007 Oct 15;12(9):397-402.
CCR5 receptor inhibitors are currently being introduced into clinical practice. In some instances treatment failure is related to the selection of pre-existing CXCR4-tropic minority virus strains. Up to date it is unclear whether the outgrowth of a CXCR4 using reservoir is associated with accelerated HIV-disease. In any case, treatment with CCR5 inhibitors should only be initiated in the absence of a relevant CXCR4-tropic minority. Otherwise treatment failure and the accumulation of mutations may ensue. Tropism tests, clinical data and other laboratory parameters help to determine the risk for an individual patient to harbour CXCR4 tropic virus strains, although the negative predictive value of each of these parameters and tests is quite low. If treatment fails re-assessment of viral tropism can help to differentiate between failure due to the development of CCR5 inhibitor resistance or the selection of CXCR4-tropic virus strains. This article presents and discusses available data on viral tropism and tropism testing in the context of CCR5 inhibitor treatment.
CCR5受体抑制剂目前正在引入临床实践。在某些情况下，治疗失败与预先存在的CXCR4嗜性少数病毒株的选择有关。迄今为止，尚不清楚使用储存库的CXCR4的出现是否与加速的HIV疾病相关。无论如何，CCR5抑制剂治疗应仅在不存在相关CXCR4嗜性少数病毒株的情况下启动。否则可能会导致治疗失败和突变积累。嗜性检测、临床数据和其他实验室参数有助于确定个体患者携带CXCR4嗜性病毒株的风险，尽管这些参数和检测的阴性预测值相当低。如果治疗失败，重新评估病毒嗜性有助于区分是由于CCR5抑制剂耐药性的发展还是CXCR4嗜性病毒株的选择导致的失败。本文介绍并讨论了在CCR5抑制剂治疗背景下有关病毒嗜性和嗜性检测的现有数据。
