Department of Medicine, University of California San Francisco, San Francisco, CA 94121, USA.
Lancet. 2010 Jul 3;376(9734):49-62. doi: 10.1016/S0140-6736(10)60676-9.
Antiretroviral therapy of HIV infection has changed a uniformly fatal into a potentially chronic disease. There are now 17 drugs in common use for HIV treatment. Patients who can access and adhere to combination therapy should be able to achieve durable, potentially lifelong suppression of HIV replication. Despite the unquestioned success of antiretroviral therapy, limitations persist. Treatment success needs strict lifelong drug adherence. Although the widely used drugs are generally well tolerated, most have some short-term toxic effects and all have the potential for both known and unknown long-term toxic effects. Drug and administration costs limit treatment in resource-poor regions, and are a growing concern even in resource rich settings. Finally, complete or near complete control of viral replication does not fully restore health. Long-term treated patients who are on an otherwise effective regimen often show persistent immune dysfunction and have higher than expected risk for various non-AIDS-related complications, including heart, bone, liver, kidney, and neurocognitive diseases.
抗逆转录病毒疗法已将 HIV 感染从一种普遍致命的疾病转变为一种潜在的慢性疾病。目前有 17 种药物被广泛用于 HIV 的治疗。能够获得并坚持联合治疗的患者，应该能够实现 HIV 复制的持久、潜在的终身抑制。尽管抗逆转录病毒疗法取得了毋庸置疑的成功，但仍存在一些局限性。治疗的成功需要严格的终生药物依从性。虽然广泛使用的药物通常具有良好的耐受性，但大多数药物都有短期毒性，所有药物都有可能产生已知和未知的长期毒性。药物和管理成本限制了资源匮乏地区的治疗，即使在资源丰富的地区，这也日益成为一个问题。最后，完全或近乎完全控制病毒复制并不能完全恢复健康。长期接受治疗且治疗方案有效的患者通常表现出持续的免疫功能障碍，并且发生各种非艾滋病相关并发症的风险高于预期，包括心脏、骨骼、肝脏、肾脏和神经认知疾病。
