抗逆转录病毒药的不良反应

抗逆转录病毒药治疗取得了良好的临床效果,但另一方面,抗逆转录病毒药的不良反应也成为HIV感染病人治疗中一个日益引起重视的问题。目前临床使用的抗逆转录病毒药物的主要不良反应包括线粒体毒性,过敏 脂肪营养不良综合征,其它不良反应有胃肠道反应,引发肝炎,妊娠禁忌,增加血友病患者血发出血发生率等,此外,还简述了某些抗逆转录病毒药物的特殊不良反应。     

高效抗逆转录病毒治疗艾滋病一例

对艾滋病 (ＡＩＤＳ)抗病毒治疗最行之有效的措施是使用有效的抗人类免疫缺陷病毒 (ＨＩＶ)药物 ,通常使用联合疗法 ,包括蛋白酶抑制剂在内的二种或多种药物 ,这样的联合疗法被认为是高效的抗逆转录病毒治疗 (ＨＡＡＲＴ) ,最近我们收治 1例疗效较好 ,报告如下。病例介绍患者 ,男性 ,37岁 ,血友病 ,因反复发热半年、咳喘 1月余 ,查ＨＩＶ阳性以艾滋病收治。患者体温多在 38℃～ 39℃之间波动 ,感全身乏力、食欲减退、体重减轻 ,近 1个月发生咳喘并逐步加重 ,先后在多家医院以肺炎、肺结核 ?应用多种抗生素治疗 ,均未治愈。在某院检查ＨＩＶ…     

高效抗逆转录病毒治疗艾滋病的临床研究

目的探讨高效抗逆转录病毒治疗(HAART)对艾滋病(AIDS)的疗效。方法应用HAART对AIDS12例进行抗病毒治疗。结果抗病毒药物治疗中,6例使用进口药物、6例使用国产药物,抗病毒治疗效果均佳,目前8例血浆中已测不出病毒,12例CD4^ T细胞均有升高,一般情况均明显改善,机会性感染未再复发。结论HAART对AIDS疗效显,如条件允许应对所有艾滋病人和达到治疗标准的艾滋病病毒(HIV)携带进行HAART。     

抗逆转录病毒药物的耐药性和不良反应

简述艾滋病的高效抗逆转录病毒治疗情况.概述3类17种抗逆转录病毒治疗药物的耐药性和不良反应.17种药几乎全部可产生耐药性,既有同类药之间的交叉耐药,也有耐多药,以原发耐药为主.不良反应较多,除一般性反应外,其特殊反应是代谢障碍,以脂肪代谢障碍最多(49.0%),糖代谢障碍占20.0%,其次为骨代谢异常等.对高脂血症可用辛伐他汀治疗.     

高效抗逆转录病毒治疗艾滋病的临床疗效

目的探讨高效抗逆转录病毒治疗艾滋病(AIDS)的临床疗效。方法选取2014年1—10月安阳市第五人民医院收治的AIDS患者40例,采用随机对照方法分为对照组与试验组,各20例。对照组患者予以常规药物治疗,试验组患者予以高效抗逆转录病毒治疗。观察两组患者临床疗效、治疗前后CD4细胞绝对计数、病毒载量及不良反应发生情况。结果试验组患者总有效率高于对照组,差异有统计学意义(P<0.05);治疗前两组患者CD4细胞绝对计数、病毒数量比较,差异无统计学意义(P>0.05),治疗后试验组患者CD4细胞绝对计数高于对照组,病毒载量低于对照组,差异有统计学意义(P<0.05);试验组患者不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论高效抗逆转录病毒治疗AIDS的临床疗效显著,且不良反应少。     

抗逆转录病毒药物的肝毒性

肝毒性是与应用抗逆转录病毒药物（ART）相关的不良反应,在治疗HIV感染时可增加患者的发病率和病死率,影响HIV感染的治疗.可能的机制包括直接的药物毒性、丙型肝炎病毒和（或）乙型肝炎病毒同时感染中的免疫重建、与肝相关的过敏性反应和线粒体毒性,还可能涉及其他致病途径.高活性抗逆转录病毒药物治疗（HAART）与转氨酶水平的升高相关.在HAART中每个单独的药物在肝毒性的发展中所起的作用难以确定.仍不清楚大多数ART肝毒性的发病率.     

HIV感染妇女接受高效的抗逆转录病毒治疗可增加胎儿死亡和先兆子痫风险

目前评估研究了8768例HIV感染妇女，她们接受高效的抗逆转录病毒治疗，研究其发生胎儿死亡和先兆子痫的风险。结果显示，接受高效的抗逆转录病毒治疗的HIV感染妇女在怀孕前期发生胎儿死亡和先兆子痫的风险很高。[第一段]     

美沙酮维持治疗人员进行抗逆转录病毒治疗1例及用药思考

因部分抗逆转录病毒药物（Antiretroviral,ARV）与美沙酮存在相互作用,门诊医生需熟练掌握ARV的药理特性,既要防止引发戒断反应,也要注意过量中毒风险。因此,准确调整美沙酮维持治疗剂量,可确保社区药物维持治疗的顺利进行,提高服药人员治疗依从性和维持治疗效果。本文通过一个接受抗逆转录病毒治疗（Antiretrovirus therapy,ART）的HIV阳性社区药物维持人员的案例,来探讨美沙酮维持治疗（methadone maintenance treatment,MMT）剂量的调整方案及应对措施的思考。     

Therapeutic drug monitoring in highly active antiretroviral therapy

Importance of the field: Despite the efficacy of combination antiretroviral therapy (ART), a large proportion of patients living with HIV/AIDS on ART does not achieve or maintain adequate virological suppression. Therapeutic drug monitoring (TDM) has been utilised to improve treatment outcomes of ART.

Areas covered in the review: The potential incorporation of TDM into the clinical HIV management is supported by the existing relationship between drug exposure and efficacy/toxicity, the high inter-patient variability pharmacokinetics, and the accurate, specific and rapid method for drug level determination. The current status of TDM in ART is reviewed in this article with discussions on its feasibility, potential use and limitations.

What the reader will gain: Mounting evidence from clinical trials has indicated the potential use of TDM in reducing the rates of treatment failure and adverse effect, avoiding the drug interactions, and special populations, such as children, pregnant women and patients with co-infections. TDM may play an important role even in resource-limited settings, to safeguard expanded use of bioequivalent generic antiretroviral drugs and avoid drug interactions with traditional Chinese medicines.

Take home message: TDM is still in the centre of controversy in that several critical issues need to be addressed, such as limited adherence assessment, inappropriate response predictors, insufficient validation of target concentration windows and lack of the quality control of assay. The utility of TDM will remain experimental until more data are obtained from large clinical trials showing the benefit of TDM.     

高效抗逆转录病毒疗法相关性代谢并发症研究进展

高效抗逆转录病毒疗法 (HAART)使人免疫缺陷病毒 (HIV)感染的发病率及病死率明显降低,但常引起代谢并发症,包括脂肪代谢障碍、血脂异常、高血糖、高乳酸血症及骨质疏松等,机制未完全阐明。有报道在接受HAART的HIV阳性病人,提前发生冠心病及心肌梗死的危险性上升。     

Identification, management, and prevention of adverse effects associated with highly active antiretroviral therapy.

PURPOSE: The adverse effects associated with highly active antiretroviral therapy (HAART), as well as potential options available for management of these complications, are summarized. SUMMARY: Effective treatment of human immunodeficiency virus (HIV) infection requires three or four drug regimens that are complicated and commonly associated with adverse effects. This makes compliance difficult and can result in treatment failures, development of resistance, and loss of future treatment options. In addition, some adverse effects may lead to an increase in morbidity and represent additional risk factors for future complications. Serious adverse events after the initiation of HAART are related to both patient and treatment characteristics. Most organ systems can be affected, depending on the drug or class of drugs being used; therefore, proper identification of adverse effects can be difficult. The most common adverse effects are gastrointestinal, neurologic, metabolic, and cardiovascular, although renal, dermatological, and hematologic events may also be encountered. Adverse-effect management has included treatment interruptions and therapeutic drug monitoring but most commonly involves switching to another drug or class of drugs. This requires a complete understanding of HAART regimens and their associated complications. HIV clinics that have employed clinical pharmacists have been able to successfully prevent or identify adverse effects through suggestions for effective treatment alternatives, medication counseling, and compliance education. CONCLUSION: The identification, management, and prevention of adverse events associated with HAART can be difficult but are integral components of effective treatment. Proper interventions are cost-effective and have resulted in improved quality of life for patients infected with HIV.     

河南省艾滋病儿童抗病毒治疗效果分析

目的明确艾滋病（AIDS）儿童抗病毒药物的治疗效果,了解抗病毒治疗对AIDS儿童的生长发育情况的影响。方法符合治疗标准的AIDS儿童给予抗病毒治疗并随访2年,每半年对AIDS儿童的身高、体重及外周血CD4＋T淋巴细胞、病毒载量等进行检测并分析,评估AIDS儿童抗病毒治疗效果及生长发育状况。结果AIDS儿童经一线方案抗病毒治疗后CD4＋T淋巴细胞计数升高,较基线水平差异具有统计学意义（P〈0.05）,二线方案抗病毒治疗后CD4＋T淋巴细胞较基线水平差异无统计学意义（P〉0.05）。AIDS儿童基线身高、体重均低于同龄正常儿童,差异具有统计学意义（P〈0.05）,经抗病毒治疗后身高、体重与同龄正常儿童差距减小,差异具有统计学意义（P〈0.05）。结论抗病毒治疗能够有效提高AIDS儿童机体免疫力,提升儿童的生长发育水平;更早期、更长期的抗病毒治疗能否使AIDS儿童的生长发育水平达到正常,仍需开展进一步的研究。     

Management of CMV retinitis in the era of highly active antiretroviral therapy

Although the epidemiological features of CMV retinitis is changing in patients receiving highly active antiretroviral therapy (HAART), continued attention must be paid to detect and treat earlier CMV infections in AIDS patients to prevent severe ophthalmic complications. Initial therapy must be based on characteristics of the CMV retinitis and patient conditions. Long term therapy of HAART must be pursued, even in patients with increased CD4 and undetectable HIV viral load, until results from large controlled studies are available. reserved.     

The role of pharmacological enhancement in protease inhibitor-based highly active antiretroviral therapy

Having changed the landscape in the treatment of HIV infection, the functional efficacy of current protease inhibitors (PIs) remains limited by their pharmacokinetic and pharmacodynamic profiles. Complex metabolism by the cytochrome P450 system (particularly the 3A4 isoenzyme), action of membrane drug transporter elements (such as P-glycoprotein and multi-drug resistance-associated proteins) and activation of the nuclear receptor steroid xenobiotic receptor may alter exposures and compromise the antiretroviral activity of these drugs. These factors, as well as inadequate adherence, can facilitate the emergence of PI resistance and lead to regimen failure. Coadministration of ritonavir can enhance exposures of a primary PI by inhibiting CYP3A4 metabolism, P-glycoprotein activity and multi-drug resistance protein-1-mediated efflux. Adding ritonavir, however, is not without cost. Dyslipidaemia (possibly increasing the risk of cardiovascular events), gastrointestinal intolerance, multiple drug-to-drug interactions and activation of steroid xenobiotic receptor can all result and must be balanced against the pharmacokinetic improvement rendered by the addition of ritonavir. Understanding the pharmacological origins for the variations in exposures of PIs, both between and within patients, is important for the successful use of these agents.     

The role of pharmacological enhancement in protease inhibitor-based highly active antiretroviral therapy

Importance of the field: The macrolides are a class of antibiotics widely prescribed in infectious disease. More recently, there has been considerable interest in potential indications for these agents, in addition to their simple antibacterial indications, in a number of lung pathophysiologies.

Areas covered in this review: Demonstrated clinical efficacy of macrolides in diseases such as diffuse panbronchiolitis was difficult to ascribe to a direct antimicrobial action. More recently, positive experiences in dealing with post-transplant bronchiolitis obliterans syndrome suggests that other chronic lung diseases may benefit from macrolide therapy. This is important, as the treatment options for such diseases are often very limited. In this review, potential antibiotic and non-antibiotic beneficial actions of macrolide therapy are discussed and conclusions drawn from a limited but growing literature.

What the reader will gain: The reader will gain an overview of lung diseases that may benefit from macrolides, and a consideration of the possible mechanisms underlying such benefit.

Take home message: The key message from our review is that this class of agents may prove to be a useful therapeutic option for a range of respiratory diseases, but that further trials and mechanistic studies are required to clarify their role.