De José Gómez M I
Servicio Infecciosos, Hospital Infantil La Paz, Madrid.
Allergol Immunopathol (Madr). 1998 May-Jun;26(3):139-44.
The treatment of HIV infection has changed recently in children and adults. The new guidelines are based on a better knowledge of viral pathogenesis, control of the infection and treatment effectiveness using the viral load, and the availability of new antiretroviral drugs. Cumulative clinical experience and the results of therapeutic trials suggest that treatment should begin early, before immune system disorders occur, in order to prevent viral dissemination and neurological involvement. Combined therapy with at least two drugs is recommended, although triple therapy with two inhibitors of inverse transcriptase and a protease inhibitor is advised as a way to delay the appearance and selection of resistant viral strains. Given the complexity of these treatment guidelines, the side effects of antiretroviral agents, and drug interactions with many medications, meticulous and detailed information for the family and child is necessary to ensure compliance and guarantee therapeutic effectiveness. The object should be to achieve an individualized and rational therapy that is adapted to the childís schedule and uses the drug formulation that the child best tolerates. The are reasons for optimism because new drugs are being developed and many of our patients will undoubtedly benefit from them. However, it should not be forgotten that many children with HIV infection in the third world cannot receive treatment for social and economic reasons.
最近，儿童和成人艾滋病病毒（HIV）感染的治疗方法有所改变。新指南基于对病毒发病机制、利用病毒载量控制感染和治疗效果的更深入了解，以及新型抗逆转录病毒药物的可获得性。累积的临床经验和治疗试验结果表明，治疗应在免疫系统紊乱出现之前尽早开始，以防止病毒传播和神经受累。建议采用至少两种药物的联合治疗，不过，建议使用两种逆转录酶抑制剂和一种蛋白酶抑制剂的三联疗法，以延缓耐药病毒株的出现和选择。鉴于这些治疗指南的复杂性、抗逆转录病毒药物的副作用以及与许多药物的相互作用，有必要为家庭和儿童提供细致而详尽的信息，以确保依从性并保证治疗效果。目标应该是实现个性化且合理的治疗，使其适应儿童的日程安排，并采用儿童耐受性最佳的药物剂型。有理由感到乐观，因为正在研发新药，我们的许多患者无疑将从中受益。然而，不应忘记，由于社会和经济原因，第三世界的许多感染HIV的儿童无法接受治疗。
