Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing and EA 2694, Faculté de Médecine de Lille, Tourcoing, France.
Curr Opin HIV AIDS. 2009 Nov;4(6):499-506. doi: 10.1097/COH.0b013e328331c478.
New antiretroviral agents have recently become available within existing and new drug classes, increasing treatment options for patients with multidrug-resistant virus. This review discusses the challenges that these new agents pose for the management of treatment-experienced patients.
Recent studies of the efficacy and safety of new antiretroviral drugs illustrate that drug regimens containing new agents are well tolerated and can suppress viremia in even the most drug-resistant patients. The goal of any new regimen should therefore be suppression of plasma HIV RNA levels to less than 50 copies/ml, even in treatment-experienced patients. Patients should be given a regimen with at least two, or preferably three, fully active drugs after careful consideration of their treatment and adherence history, current and prior genotype tests, comorbidities, and concomitant medications. Newer and more tolerable agents also offer the possibility of regimen simplification among patients with multidrug-resistant HIV who are virologically suppressed.
Clinicians must optimize the pairing and sequencing of recently available antiretroviral agents. Future studies should continue to investigate the optimal use of new agents in order to further improve long-term treatment efficacy in patients with multidrug-resistant HIV infection.
新的抗逆转录病毒药物最近已在现有和新的药物类别中可用，为多药耐药病毒患者的治疗提供了更多选择。本文讨论了这些新药物对治疗经验丰富的患者管理带来的挑战。
新的抗逆转录病毒药物的疗效和安全性研究表明，含有新药物的药物方案耐受性良好，甚至可以抑制最耐药的患者的病毒血症。因此，任何新方案的目标都应该是将血浆 HIV RNA 水平抑制到小于 50 拷贝/ml，即使在治疗经验丰富的患者中也是如此。在仔细考虑患者的治疗和依从性史、当前和先前的基因型检测、合并症和伴随用药后，应给予患者至少有两种、最好是三种完全有效的药物的方案。对于病毒学抑制的多药耐药 HIV 患者，更新和更耐受的药物也提供了简化治疗方案的可能性。
临床医生必须优化最近可用的抗逆转录病毒药物的配对和排序。未来的研究应继续调查新药物的最佳使用方法，以进一步提高多药耐药 HIV 感染患者的长期治疗效果。
