Staszewski Schlomo
HIVCENTER, Medical HIV Treatment & Research Unit, Hospital of the Johann Wolfgang Goethe University Frankfurt, 60590 Frankfurt, Germany.
Curr Opin HIV AIDS. 2007 Jan;2(1):39-45. doi: 10.1097/COH.0b013e328011aa9b.
To discuss the rationale and results of clinical trials examining treatment interruption in HIV-positive patients with advanced disease who are experiencing therapy failure.
In the past it was thought that treatment interruptions in patients experiencing therapy failure might bring about an improved virologic response to treatment via drug re-sensitization. All of the major international clinical trials, with the exception of the Giga-HAART trial, however, have found no benefit of treatment interruption in this group of patients. Moreover, most of the trials have shown an increased risk for disease progression or death. It has also been shown that even patients with no or few treatment options, staying on a failing regimen may have some clinical benefit relative to treatment interruption.
Treatment interruption in advanced failing patients may be a dangerous course of action due to the increased risk of clinical disease progression and decline in CD4 cell count. Staying on therapy, even a failing therapy, may have some benefit, at least until new drugs become available.
探讨针对病情进展且治疗失败的HIV阳性患者进行治疗中断的临床试验的基本原理及结果。
过去认为，治疗失败患者的治疗中断可能通过药物再敏化带来更好的病毒学治疗反应。然而，除了Giga-HAART试验外，所有主要的国际临床试验均未发现该组患者进行治疗中断有任何益处。此外，大多数试验表明疾病进展或死亡风险增加。研究还表明，即使是治疗选择很少或没有治疗选择的患者，相对于治疗中断，维持失败的治疗方案可能仍有一些临床益处。
晚期治疗失败患者的治疗中断可能是一个危险的做法，因为临床疾病进展风险增加且CD4细胞计数下降。维持治疗，即使是失败的治疗，可能也有一些益处，至少在有新药可用之前如此。
