Wilkin Timothy J, Gulick Roy M
Division of International Medicine and Infectious Diseases, Weill-Cornell Medical College, New York, New York 10011, USA.
Clin Infect Dis. 2008 Dec 15;47(12):1580-6. doi: 10.1086/593311.
The optimal time to start antiretroviral therapy (ART) for human immunodeficiency virus (HIV)-infected individuals remains uncertain. Although current ART regimens are effective in suppressing viremia and enhancing immune function and are increasingly convenient and well tolerated, ongoing concerns remain about adherence, drug-related toxicities, drug resistance, and cost. Although few clinical trials results are currently available to inform the question of when to start ART, large clinical cohorts clearly have demonstrated the benefits of earlier initiation of ART for reducing both HIV-related and non-HIV-related clinical events. Additional data suggest that the strategy of earlier initiation of ART is cost-effective and efficient. Consequently, many antiretroviral guidelines from around the world now recommend routine initiation of ART when the CD4 cell count decreases to <350 cells/microL or at higher CD4 cell counts for certain subgroups of HIV-infected individuals, such as pregnant and/or breast-feeding women and persons with HIV-related nephropathy or hepatitis virus coinfection. Additional cohort and clinical trials data are needed.
对于感染人类免疫缺陷病毒（HIV）的个体而言，开始抗逆转录病毒治疗（ART）的最佳时机仍不明确。尽管目前的ART方案在抑制病毒血症和增强免疫功能方面有效，且越来越方便并具有良好的耐受性，但对于依从性、药物相关毒性、耐药性及成本等问题仍存在持续担忧。虽然目前几乎没有临床试验结果可用于解答何时开始ART这一问题，但大型临床队列已明确证明，更早开始ART对于减少HIV相关和非HIV相关临床事件均有益处。其他数据表明，更早开始ART的策略具有成本效益且高效。因此，现在全球许多抗逆转录病毒指南建议，当CD4细胞计数降至<350个细胞/微升时，或对于某些HIV感染个体亚组，如孕妇和/或哺乳期妇女以及合并HIV相关肾病或肝炎病毒感染的人，在更高的CD4细胞计数时常规开始ART。还需要更多队列研究和临床试验数据。
