中国艾滋病抗病毒治疗十五年:成功与挑战

<正>从1981年美国报道第一例艾滋病至今,HIV感染已成为威胁全人类的重大传染病。自1996年高效联合抗逆转录病毒治疗（HAART）问世以来,已成为目前唯一对艾滋病治疗有效的手段[1]。HIV/AIDS患者在有效抗病毒治疗下,其平均寿命能延长数十年,艾滋病已成为一种慢性疾病,如同高血压、糖尿病一样不可以根治但可以得到长期控制。但HAART不能彻底清除患者体内的病毒,抗病毒治疗一旦起始就必须终生用     

艾滋病抗病毒治疗新进展

联合抗逆转录病毒疗法(combination antiretroviral therapy,cART)的兴起和发展改变了艾滋病的预后,控制了人类免疫缺陷病毒(human immunodeficiency virus,HIV)的病毒复制,使得HIV感染已经从致命性疾病转变为可治疗的慢性感染.抗逆转录病毒疗法(ART)可以减小病毒储库,保护机体免疫应答,降低了机会性感染和死亡的风险.同时,ART的普及大大降低了HIV传播的风险,一项来自53个低收入和中等收入国家的初步估计显示,ART覆盖率(接受ART的HIV感染者占所有感染者的百分比)与HIV发病率之间存在相关性[1].另外,一项南非的研究报告最近显示,ART覆盖率增加1％,HIV发病率就会下降1.1％[2].     

艾滋病的抗病毒治疗

1概述 　　艾滋病的抗病毒治疗,又称高效抗逆转录病毒疗法（Highly Active Antiretroviral Therapy,HAART）,是近年来艾滋病研究中进展最快的领域之一.     

艾滋病:成人艾滋病病毒感染者和艾滋病患者抗病毒治疗作用分析

目的本文就成人艾滋病病毒感染者和艾滋病患者抗病毒治疗的临床效果进行分析与探讨。方法选择我市某一传染病医院2013年2月至2014年4月期间收治的成人艾滋病病毒感染者和艾滋病患者50例,所有患者入院后均接受抗病毒治疗后,其后对治疗效果进行总结和分析。结果本组50例成人艾滋病病毒感染者和艾滋病患者经抗病毒治疗后,近期生存率为60%,服药依从率为80%。且经过一年时间的治疗后,CD+4T淋巴细胞计数均数呈上述发展趋势。结论在成人艾滋病病毒感染者和艾滋病患者治疗中,采用抗病毒治疗,效果理想,具有临床应用价值。     

艾滋病抗病毒治疗的研究进展

目的：探讨艾滋病抗病毒治疗最新的进展。方法：查阅国内外有关艾滋病抗病毒治疗的文献和综述加以总结。结果：艾滋病经高效抗逆转录病毒治疗(HAART)后HIV／AIDS病人的免疫力可以恢复，并能够对抗机会性感染。结论：艾滋病抗病毒治疗，可以延长病人的生命和提高病人的生存质量，人们开始考虑艾滋病治愈的可能性。     

抗病毒治疗艾滋病临床分析

目的:探讨抗病毒治疗艾滋病临床疗效,为提高艾滋病患者临床治疗效果与生活质量提供可靠依据,最终保障患者生命安全。方法:抗病毒治疗艾滋病的主要原则为采用一种非核苷类逆转录酶抑制剂联合两种核苷类逆转录酶抑制剂联合给药,临床应根据患者实际情况,如身体机能、经济情况等进行综合考虑后确定治疗方案。结果:40例艾滋病患者进行抗病毒治疗三个月后,其体内CD4T淋巴细胞水平较治疗前显著上升,艾滋病患者经抗病毒治疗三个月后,机会感染发生率为22.50%,显著低于治疗前机会感染发生率为72.50%,且P0.05,患者治疗前后机会感染发生率对比结果具有统计学意义;艾滋病患者经抗病毒治疗后出现毒副反应几率较大,主要毒副反应为胃肠道反应。结论:对艾滋病患者给予适合的抗病毒治疗措施,可有效提高患者体内CD4T淋巴细胞计数,治疗效果较为满意。     

艾滋病抗病毒治疗研究现状与进展

艾滋病的治疗是一项综合而且复杂的工作,所有治疗的总目标都是延长患者生命,提高其生活质量,而抗病毒治疗是达到该目的的最佳方法。抗病毒治疗是艾滋病防控的重要内容,得益于多种抗反转录病毒药物的相继问世。抗病毒治疗能够最大限度地抑制病毒复制,改善患者的免疫功能,显著降低艾滋病的发病率和死亡率,是目前已被证实的针对艾滋病病毒感染最有效的治疗方法。     

艾滋病抗病毒治疗的研究进展

抗反转录病毒治疗(antiretroviral therapy, ART)可有效抑制HIV复制,并能长时间将血浆中的病毒载量控制到检测限以下。然而,ART并不能清除潜伏的HIV储存库,大多数患者体内病毒在ART中断后的几周内迅速反弹,HIV感染者(people living with HIV, PLWH)需终身服药。本文从快速抗病毒治疗、新型抗反转录病毒(antiretroviral, ARV)药物和方案、功能性治愈和ART挑战4个方面对AIDS抗病毒治疗的研究进展进行阐述。     

呼和浩特市艾滋病抗病毒治疗分析

目的了解呼和浩特市HIV/AIDS抗病毒治疗1年的临床效果。方法通过"国家艾滋病网络直报系统"收集2012年至2016年574例HIV/AIDS抗病毒随访记录和检测信息,并对人口学特征、CD_4~+T淋巴细胞计数和病毒载量等进行分析。结果经抗病毒治疗1年后,HIV/AIDS CD4+T淋巴细胞计数明显增长(P0.05);同时有93.73%(538/574)的HIV/AIDS艾滋病病毒载量降至100copies/m L以下。结论呼和浩特市艾滋病抗病毒治疗效果明显。     

Antiretroviral therapy: Shifting sands

HIV/AIDS has been an extremely difficult pandemic to control. However, with the advent of antiretroviral therapy (ART), HIV has now been transformed into a chronic illness in patients who have continued treatment access and excellent long-term adherence. Existing indications for ART initiation in asymptomatic patients were based on CD4 levels; however, recent evidence has broken the shackles of CD4 levels. Early initiation of ART in HIV patients irrespective of CD4 counts can have profound positive impact on morbidity and mortality. Early initiation of ART has been found not only beneficial for patients but also to community as it reduces the risk of transmission. There have been few financial concerns about providing ART to all HIV-positive people but various studies have proven that early initiation of ART not only proves to be cost-effective but also contributes to economic and social growth of community. A novel multidisciplinary approach with early initiation and availability of ART at its heart can turn the tide in our favor in future. Effective preexposure prophylaxis and postexposure prophylaxis can also lower transmission risk of HIV in community. New understanding of HIV pathogenesis is opening new vistas to cure and prevention. Various promising candidate vaccines and drugs are undergoing aggressive clinical trials, raising optimism for an ever-elusive cure for HIV. This review describes various facets of tectonic shift in management of HIV.     

Antiretroviral therapy in HIV

The advent of highly active antiretroviral therapy (HAART) has led to a significant decline in HIV-associated morbidity and mortality. Despite these recent advances, the majority of patients with HIV/AIDS worldwide are still lacking access to treatment. To date, there are 21 approved antiretrovirals divided into four categories based on their mechanism of action. We review the basic characteristics of these antiretrovirals. We also briefly discuss current guidelines regarding the use of antiretrovirals in general as well as in special populations such as in pregnant women, in occupational exposure and non occupational exposure.     

Antiretroviral therapy associated mastopathy

Reports about bilateral breast enlargement in patients on antiretroviral therapy are rare. It forms a constituent of the human immunodeficiency virus lipodystrophy syndrome. Often clinical suspicion followed by appropriate imaging evaluation is confirmative.A case of antiretroviral therapy associated mastopathy is therefore presented here so that increased awareness would obviate the need of mastectomy in such cases. We also emphasise the role of adequate counselling in this scenario in alleviating patients’ anxiety.     

Antiretroviral therapy for HIV-infected people in Papua New Guinea: challenges and opportunities

Antiretroviral treatment services for Papua New Guineans infected with HIV (human immunodeficiency virus) have been severely limited because of the expense and difficulty in gaining access to antiretroviral drugs and the tests that are required to monitor the response of patients to them. Because some Papua New Guineans are beginning to seek out these services in Australia, clinicians are being challenged to manage the condition properly across an international border. Several case histories presented here highlight such difficulties. Progress is being made to reduce drug prices and simplify tablet-taking regimens, which has made the use of antiretroviral therapy more feasible. We briefly discuss infrastructure requirements for the more widespread provision of antiretroviral treatment services within Papua New Guinea.     

Antiretroviral therapy in adults: updated recommendations of the International AIDS Society-USA Panel

OBJECTIVE: To update recommendations for antiretroviral therapy for adult human immunodeficiency virus type 1 (HIV-1) infection, based on new information and drugs that are available. PARTICIPANTS: A 17-member international physician panel with antiretroviral research and HIV patient care experience initially convened by the International AIDS Society-USA in December 1995. EVIDENCE: Available clinical and basic science data including phase 3 controlled trials; data on clinical, virologic, and immunologic end points; research conference reports; HIV pathogenesis data; and panel expert opinion. Recommendations were limited to therapies available (US Food and Drug Administration approved) in 1999. CONSENSUS PROCESS: The panel assesses new research reports and interim results and regularly meets to consider how the new data affect therapy recommendations. Recommendations are updated via full-panel consensus. Guidelines are presented as recommendations if the supporting evidence warrants routine use in the particular situation and as considerations if data are preliminary or incomplete but suggestive. CONCLUSIONS: The availability of new antiretroviral drugs has expanded treatment choices. The importance of adherence, emerging long-term complications of therapy, recognition and management of antiretroviral failure, and new monitoring tools are addressed. Optimal care requires individualized management and ongoing attention to relevant scientific and clinical information in the field.     

湖北省HIV/AIDS接受抗病毒治疗情况及其影响因素分析

目的 分析湖北省HIV感染者/AIDS患者(简称HIV/AIDS)接受抗病毒治疗情况及其影响因素。方法 通过中国疾病预防控制信息系统收集截至2020年底湖北省HIV/AIDS的随访治疗信息,描述其人口学特征,利用Logistic回归分析其接受抗病毒治疗的影响因素。结果 截至2020年底,湖北省HIV/AIDS抗病毒治疗比例为92.96%。多因素分析结果显示,性别、年龄、文化程度、婚姻状况、报告地区类别、确诊时长、感染途径,以及基线CD4不同的患者,其不接受抗病毒治疗的风险差异有统计学意义(P<0.05)。其中女性不治疗风险是男性的0.67倍;年龄≤70岁组不治疗风险是<30岁组的2.11倍;文化程度中专/高中和大专以上者不治疗风险分别是初中及以下文化程度者的0.75倍和0.55倍;单身患者不治疗风险是在婚患者的2.14倍;外省和本省其他地市报告者不治疗风险分别是本县区报告者的1.50倍和1.43倍;确诊时长5～<10年、10～<15年、≥15年者不治疗风险分别是确诊时长<5年者的0.71倍、0.51倍和0.32倍;吸毒途径传播和异性性传播途径感染者不治疗风...