Division of Infectious Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Curr Opin HIV AIDS. 2012 Sep;7(5):415-21. doi: 10.1097/COH.0b013e328356dcb6.
We review the most recent clinical trials of integrase inhibitors (INIs) in antiretroviral therapy (ART)-experienced patients, including trails of new strategies such as intensification and simplification therapy with this new class of compounds.
After the excellent results of the first-generation INIs [raltegravir (RAL) and elvitegravir] in the treatment of ART-experienced patients, dolutegravir--a new second-generation compound in this drug class--adds the possibility of rescuing ART-experienced patients after virologic failure to first-generation INIs like RAL. RAL may have a role in an intensification strategy--adding RAL to a suppressive ART therapy--that could have an effect in avoiding new cycles of infection and cellular activation. On the contrary, RAL has clearly shown efficacy in switching away from boosted protease inhibitors (PI/r). This simplification strategy may be an interesting option in patients suffering from side effects of boosted protease inhibitors. In simplification, the length of time of HIV suppression before the switch may be used as a marker of probable success.
In ART-experienced patients INIs are a new and exciting part of the armamentarium for the control of HIV replication. INIs could play an interesting role in strategies such as intensification or simplification.
我们回顾了整合酶抑制剂（INIs）在抗逆转录病毒治疗（ART）经验患者中的最新临床试验，包括使用这一新类化合物强化和简化治疗的新策略的试验。
第一代 INIs[raltegravir（RAL）和elvitegravir]在治疗 ART 经验患者中的出色结果之后，多替拉韦--该药物类别的一种新的第二代化合物--为 RAL 等第一代 INIs 病毒学失败后的 ART 经验患者提供了挽救的可能性。RAL 可能在强化策略中发挥作用--将 RAL 加入抑制性 ART 治疗中--这可能有助于避免新的感染和细胞激活周期。相反，RAL 在从增效蛋白酶抑制剂（PI/r）转换中表现出明显的疗效。这种简化策略可能是那些因增效蛋白酶抑制剂副作用而受苦的患者的一个有趣选择。在简化中，转换前抑制 HIV 的时间长度可用作可能成功的标志。
在 ART 经验患者中，INIs 是控制 HIV 复制的新的令人兴奋的武器。INIs 可能在强化或简化等策略中发挥有趣的作用。
