Consulta Medicina Interna 2, Hospital La Paz, IdiPAZ, Paseo de la Castellana 261, Madrid, 28046, Spain.
AIDS Res Ther. 2013 Jan 24;10(1):3. doi: 10.1186/1742-6405-10-3.
While the introduction of combination highly active antiretroviral therapy (HAART) regimens represents an important advance in the management of human immunodeficiency virus (HIV)-infected patients, tolerability can be an issue and the use of several different agents may produce problems. The switch of combination HAART to ritonavir-boosted protease inhibitor (PI) monotherapy may offer the opportunity to maintain antiviral efficacy while reducing treatment complexity and the risks of toxicity. Current European AIDS Clinical Society (EACS) guidelines recognise ritonavir-boosted PI monotherapy with twice-daily lopinavir/ritonavir or once-daily darunavir/ritonavir as a possible option in patients who have intolerance to nucleoside reverse transcriptase inhibitors, or for treatment simplification. Clinical trials data for PI boosted monotherapy are encouraging, showing substantial efficacy in the majority of patients; however, further data are required before this approach can be recommended as a routine treatment. Available data indicate that the most suitable candidates for the use of boosted PI monotherapy are long-term virologically suppressed patients who have demonstrated good adherence to antiretroviral therapy, who do not have chronic hepatitis B, have no history of treatment failure on PIs and are able to tolerate low-dose ritonavir.
虽然联合高效抗逆转录病毒治疗（HAART）方案的引入代表了人类免疫缺陷病毒（HIV）感染患者治疗的重要进展，但耐受性可能是一个问题，并且使用多种不同的药物可能会产生问题。将联合 HAART 转换为利托那韦增强的蛋白酶抑制剂（PI）单药治疗可能提供维持抗病毒疗效的机会，同时减少治疗复杂性和毒性风险。目前，欧洲艾滋病临床学会（EACS）指南承认，对于不能耐受核苷逆转录酶抑制剂的患者，或为了简化治疗，利托那韦增强的 PI 单药治疗，每日两次洛匹那韦/利托那韦或每日一次达芦那韦/利托那韦可能是一种选择。PI 增强单药治疗的临床试验数据令人鼓舞，显示出大多数患者的显著疗效；然而，在这种方法被推荐为常规治疗之前，还需要更多的数据。现有数据表明，最适合使用增强型 PI 单药治疗的患者是长期病毒学抑制的患者，他们表现出对抗病毒治疗的良好依从性，没有慢性乙型肝炎，没有 PI 治疗失败的病史，能够耐受低剂量利托那韦。
