Maenza J, Flexner C
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Am Fam Physician. 1998 Jun;57(11):2789-98.
The primary goal of antiretroviral therapy for human immunodeficiency virus (HIV) infection is suppression of viral replication. Evidence indicates that the optimal way to achieve this goal is by initiating combination therapy with two or more antiretroviral agents. The agents now licensed in the United States for use in combination therapy include five nucleoside analog reverse transcriptase inhibitors (zidovudine, didanosine, zalcitabine, stavudine and lamivudine), two nonnucleoside reverse transcriptase inhibitors (delavirdine and nevirapine) and four protease inhibitors (saquinavir, ritonavir, indinavir and nelfinavir). Current recommendations suggest that antiretroviral therapy be considered in any patient with a viral load higher than 5,000 to 20,000 copies per mL, regardless of the CD4+ count. Selection of the combination regimen must take into account the patient's prior history of antiretroviral use, the side effects of these agents and drug-drug interactions that occur among these agents and with other drugs as well. Because of the potential for viral resistance, nonnucleoside reverse transcriptase inhibitors and protease inhibitors should only be used in combination therapy. Antiretroviral agents are rapidly being developed and approved, so physicians must make increasingly complex treatment decisions about medications with which they may be unfamiliar.
人类免疫缺陷病毒（HIV）感染的抗逆转录病毒疗法的主要目标是抑制病毒复制。有证据表明，实现这一目标的最佳方法是开始使用两种或更多种抗逆转录病毒药物进行联合治疗。目前在美国被批准用于联合治疗的药物包括五种核苷类似物逆转录酶抑制剂（齐多夫定、去羟肌苷、扎西他滨、司他夫定和拉米夫定）、两种非核苷逆转录酶抑制剂（地拉韦啶和奈韦拉平）以及四种蛋白酶抑制剂（沙奎那韦、利托那韦、茚地那韦和奈非那韦）。目前的建议是，对于任何病毒载量高于每毫升5000至20000拷贝的患者，无论其CD4 + 细胞计数如何，都应考虑进行抗逆转录病毒治疗。联合治疗方案的选择必须考虑患者既往使用抗逆转录病毒药物的病史、这些药物的副作用以及这些药物之间以及与其他药物之间发生的药物相互作用。由于存在病毒耐药的可能性，非核苷逆转录酶抑制剂和蛋白酶抑制剂仅应在联合治疗中使用。抗逆转录病毒药物正在迅速研发和获批，因此医生必须就他们可能不熟悉的药物做出越来越复杂的治疗决策。
