抗逆转录病毒疗法的发展及其对 HIV-1/AIDS 大流行的影响。
The development of antiretroviral therapy and its impact on the HIV-1/AIDS pandemic.
机构信息
Celera Corporation, 1401 Harbor Bay Pkwy, Alameda, CA 94502-7070, USA.
出版信息
Antiviral Res. 2010 Jan;85(1):1-18. doi: 10.1016/j.antiviral.2009.10.002. Epub 2009 Dec 16.
In the last 25 years, HIV-1, the retrovirus responsible for the acquired immunodeficiency syndrome (AIDS), has gone from being an "inherently untreatable" infectious agent to one eminently susceptible to a range of approved therapies. During a five-year period, starting in the mid-1980s, my group at the National Cancer Institute played a role in the discovery and development of the first generation of antiretroviral agents, starting in 1985 with Retrovir (zidovudine, AZT) in a collaboration with scientists at the Burroughs-Wellcome Company (now GlaxoSmithKline). We focused on AZT and related congeners in the dideoxynucleoside family of nucleoside reverse transcriptase inhibitors (NRTIs), taking them from the laboratory to the clinic in response to the pandemic of AIDS, then a terrifying and lethal disease. These drugs proved, above all else, that HIV-1 infection is treatable, and such proof provided momentum for new therapies from many sources, directed at a range of viral targets, at a pace that has rarely if ever been matched in modern drug development. Antiretroviral therapy has brought about a substantial decrease in the death rate due to HIV-1 infection, changing it from a rapidly lethal disease into a chronic manageable condition, compatible with very long survival. This has special implications within the classic boundaries of public health around the world, but at the same time in certain regions may also affect a cycle of economic and civil instability in which HIV-1/AIDS is both cause and consequence. Many challenges remain, including (1) the life-long duration of therapy; (2) the ultimate role of pre-exposure prophylaxis (PrEP); (3) the cardiometabolic side-effects or other toxicities of long-term therapy; (4) the emergence of drug-resistance and viral genetic diversity (non-B subtypes); (5) the specter of new cross-species transmissions from established retroviral reservoirs in apes and Old World monkeys; and (6) the continued pace of new HIV-1 infections in many parts of the world. All of these factors make refining current therapies and developing new therapeutic paradigms essential priorities, topics covered in articles within this special issue of Antiviral Research. Fortunately, there are exciting new insights into the biology of HIV-1, its interaction with cellular resistance factors, and novel points of attack for future therapies. Moreover, it is a short journey from basic research to public health benefit around the world. The current science will lead to new therapeutic strategies with far-reaching implications in the HIV-1/AIDS pandemic. This article forms part of a special issue of Antiviral Research marking the 25th anniversary of antiretroviral drug discovery and development, Vol. 85, issue 1, 2010.
在过去的 25 年中,导致获得性免疫缺陷综合征(AIDS)的逆转录病毒 HIV-1 已经从一种“本质上无法治疗”的传染性病原体转变为对一系列批准的治疗方法高度敏感。从 20 世纪 80 年代中期开始,我的国家癌症研究所的团队在发现和开发第一代抗逆转录病毒药物方面发挥了作用,从 1985 年开始与 Burroughs-Wellcome 公司(现为葛兰素史克)的科学家合作开发了 Retrovir(齐多夫定,AZT)。我们专注于 AZT 和相关的脱氧核苷酸类似物,它们是核苷逆转录酶抑制剂(NRTIs)家族中的双脱氧核苷,我们将它们从实验室带到临床,以应对当时可怕且致命的艾滋病大流行。这些药物首先证明 HIV-1 感染是可以治疗的,这为来自许多来源的新疗法提供了动力,这些疗法针对多种病毒靶点,以现代药物开发中很少出现的速度发展。抗逆转录病毒疗法使因 HIV-1 感染而导致的死亡率大幅下降,将其从一种快速致命的疾病转变为一种可以长期控制的慢性疾病,与非常长的生存时间兼容。这在全球公共卫生的经典范围内具有特殊意义,但同时在某些地区也可能影响到 HIV-1/AIDS 既是原因又是后果的经济和公民不稳定周期。仍然存在许多挑战,包括(1)终身治疗时间;(2)暴露前预防(PrEP)的最终作用;(3)长期治疗的代谢副作用或其他毒性;(4)药物耐药性和病毒遗传多样性(非 B 亚型)的出现;(5)来自猿类和旧世界猴中已建立的逆转录病毒储库的新跨物种传播的威胁;(6)世界许多地区新的 HIV-1 感染仍在继续。所有这些因素使得完善当前疗法和开发新的治疗模式成为当务之急,本抗病毒研究特刊中的文章涵盖了这些主题。幸运的是,人们对 HIV-1 的生物学、其与细胞耐药因素的相互作用以及未来治疗的新攻击点有了令人兴奋的新见解。此外,从基础研究到全球公共卫生的好处是很短的旅程。目前的科学将导致具有深远影响的新的治疗策略,在 HIV-1/AIDS 大流行中。本文是抗病毒研究特刊的一部分,该特刊标志着抗逆转录病毒药物发现和开发 25 周年,第 85 卷,第 1 期,2010 年。