Katlama Christine, Ghosn Jade
University Pierre et Marie Curie Paris VI, Hopital Pitié-Salpetriere, Paris, France.
Curr Opin HIV AIDS. 2006 Nov;1(6):495-501. doi: 10.1097/COH.0b013e328010f226.
To report on recent clinical studies in highly experienced patients with multiple exposures and failures to therapies using new drugs - either new drugs with a different resistance profile or a new class of drugs.
The major concern in a situation of salvage therapy is the capacity to build an antiretroviral regimen with sufficient potency to circumvent the intensity of viral replication and resistance of the virus. New drugs represent the major weapon in that fight. Several drugs have been developed in the past few years that have allowed a change in the paradigm for salvage therapy. They belong either to the old class of protease inhibitors but have been designed to target resistant viruses (tipranavir, darunavir), or to a new class such as fusion inhibitors, entry co-receptor inhibitors or integrase inhibitors.
Due to their potency and their ability to combine in a salvage regimen, the new drugs have allowed us to revisit the paradigm for managing treatment failure. Until recently it was estimated that one log drop in viral load was acceptable as the primary endpoint in salvage studies. Recent results now suggest that undetectability of the viral load has become a realistic target.
报告近期针对多次暴露且对使用新药（具有不同耐药谱的新药或新型药物）治疗失败的经验丰富患者开展的临床研究。
挽救治疗中的主要问题是构建具有足够效力的抗逆转录病毒治疗方案，以克服病毒复制强度和病毒耐药性。新药是这场斗争中的主要武器。在过去几年中已研发出几种药物，它们改变了挽救治疗的模式。这些药物要么属于旧的蛋白酶抑制剂类别，但设计用于靶向耐药病毒（替拉那韦、达芦那韦），要么属于新型药物，如融合抑制剂、进入共受体抑制剂或整合酶抑制剂。
由于新药的效力及其在挽救治疗方案中的联合使用能力，使我们能够重新审视治疗失败的管理模式。直到最近，在挽救研究中，病毒载量下降一个对数级被认为是可接受的主要终点。现在的最新结果表明，病毒载量检测不到已成为一个现实目标。
