Endocrinology, Nutrition, and Growth Branch, Center for Research for Mothers and Children, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.
Am J Clin Nutr. 2011 Dec;94(6):1697S-1702S. doi: 10.3945/ajcn.111.019109. Epub 2011 Nov 16.
Food and nutrition play an intimate and inextricable role in all aspects of drug metabolism, safety, and effectiveness. Antiretroviral therapies (ART) have assumed a preeminent position in the prevention, care, and treatment of HIV and its comorbidities. The interaction between food, nutrition, and ART has become an expanding area of interest both in terms of clinical standards of care and as a target for research. Since the original review of this topic by the WHO in 2005, much has been learned (8). This article contains a review of what is known about the general relationships between nutrition and pharmacology, as well as issues specific to ART, with particular attention to their use in low- and middle-resource settings. The importance of food and nutrition on the bioavailability of drugs and vice versa has been an area of historical interest. However, much has been learned about the importance of nutritional status on drug metabolism, distribution, and effectiveness. The impact of traditional therapies (herbal/botanical) is highlighted as an area of clinical concern and one in need of further research. Additional attention is focused on the impact of individual micronutrients on drug pharmacokinetics and pharmacodynamics. Finally, attention is given to the nutritional implications of the metabolic consequences of ART, which include the potential impact of "colliding epidemics" of infection (eg, HIV, tuberculosis) and noncommunicable diseases. Much has been learned, but much remains to be accomplished to ensure the effective integration of nutritional considerations into the effective and safe use of ART.
食物和营养在药物代谢、安全性和有效性的各个方面都起着密切和不可分割的作用。抗逆转录病毒疗法（ART）在预防、护理和治疗 HIV 及其合并症方面占据了首要地位。食物、营养和 ART 之间的相互作用已成为关注的一个不断扩大的领域，无论是在临床护理标准方面，还是作为研究的目标。自 2005 年世卫组织首次审查该主题以来，已经取得了很多了解（8）。本文回顾了关于营养与药理学之间的一般关系以及特定于 ART 的问题的已知内容，特别关注它们在低资源和中等资源环境中的使用。食物和营养对药物生物利用度的影响以及反之亦然，一直是历史上关注的一个领域。然而，人们已经了解到营养状况对药物代谢、分布和有效性的重要性。传统疗法（草药/植物药）的影响被强调为临床关注的一个领域，也是需要进一步研究的一个领域。此外，还重点关注了个别微量营养素对药物药代动力学和药效学的影响。最后，关注了 ART 代谢后果的营养影响，其中包括“碰撞性流行”感染（如 HIV、结核病）和非传染性疾病的潜在影响。已经取得了很多了解，但为了确保将营养考虑有效纳入 ART 的有效和安全使用，还有很多工作要做。
