Unit of Infectious Diseases, ASST Papa Giovanni XXIII, Bergamo, Italy.
A Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico - B Department of Pathophysiology and Transplantation, University of Milan, Milano, Italy.
Expert Rev Anti Infect Ther. 2021 Apr;19(4):443-456. doi: 10.1080/14787210.2021.1823217. Epub 2020 Oct 15.
Antiretroviral therapy (ART) is the most significant advance in the medical management of HIV-1 infection. Given the fact that HIV cannot be eradicated from the body, ART has to be indefinitely maintained. New approaches need to be defined for monitoring HIV-infected individuals (PLWHIV), including clinical, virologic, immunological parameters and also ways to collect individual points of view and quality of life.
We discuss which tests may be used to improve the management of PLWHIV and respond to a comprehensive health demand.
Viral load and CD4 counts are well-validated outcome measures and we still need them, but they do not completely depict the health status of PLWHIV. We need to better understand and to apply to clinical practice what happens in sanctuaries, what is the role of HIV DNA, what is the meaning of low-level viremia. Most of these questions do not yet have a definitive response. Further, we need to understand how to modify these variables in order to improve outcomes.Similar points may be raised for immunological measures and for tests exploring the tolerability of drugs. The goal must be the evolution from a viro/immunologic-based to a comprehensive quality-of-health-based evaluation of PLWHIV.
抗逆转录病毒疗法（ART）是 HIV-1 感染医学管理方面的重大进展。鉴于 HIV 无法从体内清除，因此必须无限期维持 ART。需要为监测 HIV 感染者（PLWHIV）定义新方法，包括临床、病毒学、免疫学参数，以及收集个人观点和生活质量的方法。
我们讨论了哪些检测方法可以用于改善 PLWHIV 的管理并满足全面的健康需求。
病毒载量和 CD4 计数是经过充分验证的疗效指标，我们仍然需要它们，但它们并不能完全描述 PLWHIV 的健康状况。我们需要更好地理解并将庇护所中的情况、HIV DNA 的作用、低水平病毒血症的意义应用于临床实践。这些问题大多尚未有明确的答案。此外，我们需要了解如何改变这些变量以改善结果。免疫措施和探索药物耐受性的检测也存在类似的问题。目标必须是从基于病毒学/免疫学的评估演变为基于全面健康质量的评估。
