Hammer S M
Division of Infectious Diseases, Deaconess Hospital, Boston, MA, USA.
AIDS. 1996 Dec;10 Suppl 3:S1-11.
To highlight recent developments in the field of antiretroviral therapy and viral load monitoring.
Review of studies detailing the efficacy of the antiretroviral agents and combinations furthest along in clinical development and the application of plasma HIV RNA quantification as a disease marker.
Developments in the field of antiretroviral therapy have led to substantial advances in the approach to management of HIV-infected persons. These include the end of the zidovudine (ZDV) monotherapy era; the demonstration of a survival benefit conferred by antiretroviral therapy in patients with CD4 counts of 200-500x10(6)/l; the further development of newer nucleoside analog combinations (e.g., ZDV-lamivudine, stavudine-didanosine, stavudine-lamivudine, ZDV-1592U89) and the non-nucleoside reverse transcriptase inhibitor class of compounds; and, perhaps most importantly, the advent of the protease inhibitor era. Trials of ritonavir and saquinavir have proven that clinical benefit can be conferred by protease inhibitors, and three-drug combination regimens, such as indinavir-ZDV-lamivudine, have shown the potential for degrees of viral suppression not previously seen. Newer protease inhibitors, such as nelfinavir and VX-478/GW141W94, hold promise for further advances. The concurrent development of assays to quantitatively measure plasma HIV RNA has provided laboratory tools to improve our understanding of disease pathogenesis, to assess the in vivo potency of treatment regimens and to characterize the risk of disease progression.
Recent progress in HIV disease pathogenesis, antiretroviral therapy and viral load monitoring indicates the interdependence of these factors. The current optimism in the field is warranted but complex challenges must be met if the fulfilment of this hope is to be realized by the world community.
强调抗逆转录病毒疗法和病毒载量监测领域的最新进展。
回顾详细阐述抗逆转录病毒药物及临床进展最前沿的联合用药疗效以及血浆HIV RNA定量作为疾病标志物应用的研究。
抗逆转录病毒疗法领域的进展已使HIV感染者的管理方法取得了重大进步。这些进展包括齐多夫定（ZDV）单药治疗时代的结束；抗逆转录病毒疗法对CD4细胞计数为200 - 500×10⁶/l的患者有生存益处的证明；新型核苷类似物联合用药（如ZDV - 拉米夫定、司他夫定 - 去羟肌苷、司他夫定 - 拉米夫定、ZDV - 1592U89）和非核苷类逆转录酶抑制剂类化合物的进一步研发；以及或许最重要的，蛋白酶抑制剂时代的到来。利托那韦和沙奎那韦的试验已证明蛋白酶抑制剂可带来临床益处，而茚地那韦 - ZDV - 拉米夫定等三联药物联合治疗方案已显示出前所未有的病毒抑制程度的潜力。新型蛋白酶抑制剂，如奈非那韦和VX - 478/GW141W94，有望取得进一步进展。同时，用于定量测量血浆HIV RNA的检测方法的发展提供了实验室工具，以增进我们对疾病发病机制的理解，评估治疗方案的体内效力并确定疾病进展风险。
HIV疾病发病机制、抗逆转录病毒疗法和病毒载量监测方面的近期进展表明了这些因素的相互依存关系。该领域目前的乐观态度是有道理的，但如果国际社会要实现这一希望，就必须应对复杂的挑战。
