AIDS Research Consortium of Atlanta, 131 Ponce de Leon Ave NE, Ste 130, Atlanta, GA 30308, USA.
JAMA. 2012 Jul 25;308(4):387-402. doi: 10.1001/jama.2012.7961.
New trial data and drug regimens that have become available in the last 2 years warrant an update to guidelines for antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-infected adults in resource-rich settings.
To provide current recommendations for the treatment of adult HIV infection with ART and use of laboratory-monitoring tools. Guidelines include when to start therapy and with what drugs, monitoring for response and toxic effects, special considerations in therapy, and managing antiretroviral failure.
DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: Data that had been published or presented in abstract form at scientific conferences in the past 2 years were systematically searched and reviewed by an International Antiviral Society-USA panel. The panel reviewed available evidence and formed recommendations by full panel consensus.
Treatment is recommended for all adults with HIV infection; the strength of the recommendation and the quality of the evidence increase with decreasing CD4 cell count and the presence of certain concurrent conditions. Recommended initial regimens include 2 nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine or abacavir/lamivudine) plus a nonnucleoside reverse transcriptase inhibitor (efavirenz), a ritonavir-boosted protease inhibitor (atazanavir or darunavir), or an integrase strand transfer inhibitor (raltegravir). Alternatives in each class are recommended for patients with or at risk of certain concurrent conditions. CD4 cell count and HIV-1 RNA level should be monitored, as should engagement in care, ART adherence, HIV drug resistance, and quality-of-care indicators. Reasons for regimen switching include virologic, immunologic, or clinical failure and drug toxicity or intolerance. Confirmed treatment failure should be addressed promptly and multiple factors considered.
New recommendations for HIV patient care include offering ART to all patients regardless of CD4 cell count, changes in therapeutic options, and modifications in the timing and choice of ART in the setting of opportunistic illnesses such as cryptococcal disease and tuberculosis.
在过去的 2 年中，新的临床试验数据和药物方案已经出现，这使得资源丰富环境下的人类免疫缺陷病毒（HIV）感染成人抗逆转录病毒治疗（ART）指南需要更新。
为 HIV 感染成人的 ART 治疗和实验室监测工具的使用提供当前建议。指南包括何时开始治疗以及使用何种药物、监测反应和毒性作用、治疗中的特殊考虑因素以及管理抗逆转录病毒治疗失败。
数据来源、研究选择和数据提取：系统地搜索并审查了过去 2 年内发表或在科学会议上以摘要形式呈现的最新数据，该数据由国际抗病毒学会-美国小组提供。该小组审查了现有证据，并通过全体小组协商达成了建议。
建议对所有 HIV 感染的成年人进行治疗；建议的强度和证据的质量随着 CD4 细胞计数的降低和某些共存疾病的存在而增加。建议的初始方案包括 2 种核苷逆转录酶抑制剂（替诺福韦/恩曲他滨或阿巴卡韦/拉米夫定）加非核苷逆转录酶抑制剂（依非韦伦）、利托那韦增强的蛋白酶抑制剂（阿扎那韦或达芦那韦）或整合酶链转移抑制剂（拉替拉韦）。对于有或有某些共存疾病风险的患者，建议在每个类别中选择替代方案。应监测 CD4 细胞计数和 HIV-1 RNA 水平，以及参与护理、ART 依从性、HIV 药物耐药性和护理质量指标。方案转换的原因包括病毒学、免疫学或临床失败以及药物毒性或不耐受。应迅速解决确认的治疗失败，并考虑多种因素。
新的 HIV 患者护理建议包括向所有患者提供 ART，无论 CD4 细胞计数如何，改变治疗选择，以及在机会性疾病（如隐球菌病和结核病）的情况下调整 ART 的时机和选择。
