St Stephens Research, St Stephens Centre, Chelsea & Westminster Hospital, 369 Fulham Road, London, UK.
Expert Rev Anti Infect Ther. 2011 Oct;9(10):877-89. doi: 10.1586/eri.11.106.
Late presentation of HIV is common and is associated with several adverse outcomes including an increased risk of clinical progression, blunted immune recovery on highly active antiretroviral therapy and a greater risk of drug toxicity. Late presenters may have higher rates of poor adherence, exacerbated by the same factors that contribute to their late diagnosis, such as lack of knowledge about HIV and the benefits of highly active antiretroviral therapy. We review the definitions of, risk factors for and subsequent impact of late presentation. Evidence regarding how and when to start antiretroviral therapy, and with which agents, will be discussed, as well as issues surrounding vaccination and opportunistic infection prophylaxis for individuals with a low CD4 count. Finally, strategies to increase HIV testing uptake to reduce late presentation will be summarized.
HIV 的晚期发病较为常见，与多种不良结局相关，包括临床进展风险增加、高效抗逆转录病毒治疗（highly active antiretroviral therapy，HAART）后免疫恢复受损，以及药物毒性风险增加。晚期发病者的治疗依从性可能较差，这与导致其晚期诊断的因素有关，例如缺乏对 HIV 及高效抗逆转录病毒治疗益处的了解。我们将对晚期发病的定义、风险因素及其后续影响进行综述。同时，我们还将讨论何时以及如何开始抗逆转录病毒治疗，以及选择哪种药物进行治疗，以及针对 CD4 计数较低的个体的疫苗接种和机会性感染预防问题。最后，我们将总结提高 HIV 检测率以减少晚期发病的策略。
