Enferm Infecc Microbiol Clin. 2015 Oct;33(8):543.e1-43. doi: 10.1016/j.eimc.2015.03.016. Epub 2015 May 7.
This consensus document is an update of combined antiretroviral therapy (cART) guidelines and recommendations for HIV-1 infected adult patients.
To formulate these recommendations, a panel composed of members of the AIDS Study Group and the AIDS National Plan (GeSIDA/Plan Nacional sobre el Sida) reviewed the efficacy and safety advances in clinical trials, and cohort and pharmacokinetic studies published in medical journals (PubMed and Embase) or presented in medical scientific meetings. The strength of the recommendations, and the evidence that supports them, are based on modified criteria of the Infectious Diseases Society of America.
In this update, cART is recommended for all patients infected by type 1 human immunodeficiency virus (HIV-1). The strength and level of the recommendation depends on the CD4+T-lymphocyte count, the presence of opportunistic diseases or comorbid conditions, age, and prevention of transmission of HIV. The objective of cART is to achieve an undetectable plasma viral load. Initial cART should always comprise a combination of 3 drugs, including 2 nucleoside reverse transcriptase inhibitors, and a third drug from a different family. Three out of the ten recommended regimes are regarded as preferential (all of them with an integrase inhibitor as the third drug), and the other seven (based on a non-nucleoside reverse transcriptase inhibitor, a ritonavir-boosted protease inhibitor, or an integrase inhibitor) as alternatives. This update presents the causes and criteria for switching cART in patients with undetectable plasma viral load, and in cases of virological failure where rescue cART should comprise 3 (or at least 2) drugs that are fully active against the virus. An update is also provided for the specific criteria for cART in special situations (acute infection, HIV-2 infection, and pregnancy) and with comorbid conditions (tuberculosis or other opportunistic infections, kidney disease, liver disease, and cancer).
These new guidelines update previous recommendations related to cART (when to begin and what drugs should be used), how to monitor and what to do in case of viral failure or drug adverse reactions. cART specific criteria in comorbid patients and special situations are equally updated.
本共识文件是对成人HIV-1感染患者联合抗逆转录病毒治疗（cART）指南及建议的更新。
为制定这些建议，由艾滋病研究小组和国家艾滋病计划（西班牙艾滋病研究与防治协作组/国家艾滋病计划）成员组成的专家小组审查了医学期刊（PubMed和Embase）发表或在医学科学会议上展示的临床试验、队列研究及药代动力学研究中的疗效和安全性进展。建议的力度及其支持证据基于美国传染病学会的修订标准。
在本次更新中，建议对所有1型人类免疫缺陷病毒（HIV-1）感染患者进行cART治疗。建议的力度和级别取决于CD4+T淋巴细胞计数、机会性疾病或合并症的存在情况、年龄以及HIV传播的预防。cART的目标是使血浆病毒载量检测不到。初始cART应始终包含3种药物的组合，包括2种核苷类逆转录酶抑制剂，以及来自不同类别（家族）的第三种药物。推荐的10种治疗方案中有3种被视为首选方案（均以整合酶抑制剂作为第三种药物），另外7种（基于非核苷类逆转录酶抑制剂、利托那韦增强的蛋白酶抑制剂或整合酶抑制剂）为替代方案。本次更新介绍了血浆病毒载量检测不到的患者更换cART的原因和标准，以及病毒学失败时挽救性cART应包含3种（或至少2种）对病毒完全有效的药物的情况。还提供了特殊情况（急性感染、HIV-2感染和妊娠）以及合并症（结核病或其他机会性感染、肾脏疾病、肝脏疾病和癌症）中cART的具体标准的更新内容。
这些新指南更新了先前关于cART的建议（何时开始以及应使用何种药物）、如何监测以及病毒学失败或药物不良反应时应如何处理。合并症患者和特殊情况下cART的具体标准也同样得到了更新。
