HIV therapy最新文献

英文中文

HIV-related cryptococcal meningitis in resource-limited settings 在资源有限的环境中与hiv相关的隐球菌脑膜炎

HIV therapy

Pub Date : 2010-10-25 DOI: 10.2217/HIV.10.46

A. Chirianni, V. Esposito

Cryptococcal infection remains a significant problem in patients with AIDS in resource-limited settings. Even with the availability of HAART, the 6-month rate of survival after cryptococcal meningitis (CM) reported by several epidemiological studies is very low. The worldwide number of infections and deaths due to CM appears similar to those for diseases that have received greater public health attention. In sub-Saharan Africa, deaths due to CM may be more frequent than TB. However, in many developing countries the capacity to perform the complicated management of severe CM is limited and CM mortality may remain a problem in Africa, and also in areas where antiretroviral therapy is available, as late presentation with advanced disease is common and consequently IRIS is becoming an emerging problem. A focused effort to improve diagnostic capacity, expand treatment options, and identify effective measures for the prevention of cryptococcal disease is urgently required.

在资源有限的环境中，隐球菌感染仍然是艾滋病患者的一个重大问题。即使有高效抗逆转录病毒治疗，几项流行病学研究报告的隐球菌脑膜炎(CM)后6个月存活率非常低。全世界由CM引起的感染和死亡人数似乎与那些受到更多公共卫生关注的疾病相似。在撒哈拉以南非洲，CM造成的死亡可能比结核病更为频繁。然而，在许多发展中国家，对严重CM进行复杂管理的能力有限，CM的死亡率在非洲和可获得抗逆转录病毒治疗的地区可能仍然是一个问题，因为晚期疾病出现较晚，因此IRIS正在成为一个新出现的问题。迫切需要集中努力提高诊断能力，扩大治疗选择，并确定预防隐球菌病的有效措施。

引用次数: 2

The impact of baseline characteristics on virologic response to etravirine: 48-week pooled analysis of DUET-1 and DUET-2 基线特征对依曲维林病毒学反应的影响:对DUET-1和DUET-2的48周汇总分析

HIV therapy

Pub Date : 2010-10-25 DOI: 10.2217/HIV.10.41

P. Cahn, R. Haubrich, C. Katlama, F. Goebel, F. Suter, M. Peeters, J. Vingerhoets, R. Sinha, J. Witek

Aims: The impact of baseline characteristics on response to the non-nucleoside reverse transcriptase inhibitor etravirine was investigated at 48 weeks in the Phase III DUET trials. Methods: Logistic regression was used to examine the effect of baseline demographics, disease characteristics and characteristics of antiretroviral therapy on virologic response (viral load <50 HIV-1 RNA copies/ml) to etravirine in pre-specified pooled subgroup analyses. Results: Several nondemographic characteristics were significant predictors of response in univariate analyses. Baseline viral load, adherence to study medication and use of enfuvirtide were predictive of response in the multivariate analysis. Patients treated with etravirine consistently achieved higher response rates than placebo-treated patients. Conclusions: The clinical benefits of etravirine in the DUET trials were observed irrespective of baseline characteristics.

目的:在III期DUET试验中，研究了基线特征对非核苷类逆转录酶抑制剂etravirine应答的影响。方法:在预先指定的合并亚组分析中，采用Logistic回归分析基线人口统计学、疾病特征和抗逆转录病毒治疗特征对依曲维林病毒学反应(病毒载量<50 HIV-1 RNA拷贝/ml)的影响。结果:在单变量分析中，一些非人口学特征是反应的重要预测因子。在多变量分析中，基线病毒载量、对研究药物的依从性和恩氟韦肽的使用是预测反应的指标。接受依曲维林治疗的患者始终比接受安慰剂治疗的患者获得更高的缓解率。结论:无论基线特征如何，在DUET试验中观察到依曲维碱的临床益处。

引用次数: 10

Politics and policy in HIV/AIDS: the road ahead for South Africa 艾滋病毒/艾滋病的政治和政策:南非的前进道路

HIV therapy

Pub Date : 2010-10-25 DOI: 10.2217/HIV.10.34

H. Coovadia

Professor Hoosen Coovadia is currently working on maternal, newborn and child health, in metropolitan Durban at MatCH. He is personally and professionally committed to justice, democracy, development and freedom, during and after apartheid. He was chairperson of the Mandela government’s first Commission on Maternal and Child Health to design appropriate policies for South Africa. He has headed the largest International AIDS Conferences to be brought to South Africa and published more than 320 papers on maternal and child health in national and international journals. He publicly and consistently opposed former South African President Thabo Mbeki’s administration on their controversial AIDS policies, which denied HIV/AIDS patients antiretroviral treatment.

Hoosen Coovadia教授目前在德班大都会的MatCH从事孕产妇、新生儿和儿童健康方面的工作。在种族隔离期间和之后，他个人和专业地致力于正义、民主、发展和自由。他是曼德拉政府第一个妇幼保健委员会的主席，该委员会为南非设计适当的政策。他主持了将在南非举办的最大的国际艾滋病会议，并在国家和国际期刊上发表了320多篇关于妇幼保健的论文。他公开并一贯反对南非前总统塔博·姆贝基(Thabo Mbeki)政府有争议的艾滋病政策，这些政策拒绝为艾滋病毒/艾滋病患者提供抗逆转录病毒治疗。

引用次数: 0

Noninfectious HIV-related comorbidities and HAART toxicities: choosing alternative antiretroviral strategies 非传染性hiv相关合并症和HAART毒性:选择替代性抗逆转录病毒策略

HIV therapy

Pub Date : 2010-10-25 DOI: 10.2217/HIV.10.44

L. Gazzola, C. Tincati, A. Monforte

In the HAART era, clinicians are faced with the challenge of treating an aging HIV-infected population increasingly affected by severe comorbidities, which may compromise the tolerability of antiretroviral regimens. In this special population, it is imperative for physicians to carefully tailor antiretroviral treatment in order not to worsen patients’ underlying clinical conditions and to achieve both tolerability and immune–virologic efficacy. This article aims to explore the impact of standard HAART regimens on the different noninfectious HIV-related comorbidities: metabolic, cardiovascular, bone and renal diseases, in order to provide tools to fit the most appropriate antiretroviral combination according to individual clinical conditions. Clinical experience with alternative antiretroviral strategies, avoiding nucleoside reverse transcriptase inhibitor toxicities and involving new antiretroviral classes, will be reviewed to obtain an overview on future perspectives.

在HAART时代，临床医生面临着治疗日益受到严重合并症影响的老年艾滋病毒感染者的挑战，这些合并症可能会损害抗逆转录病毒治疗方案的耐受性。在这一特殊人群中，医生必须仔细定制抗逆转录病毒治疗，以免恶化患者的潜在临床状况，并实现耐受性和免疫病毒学疗效。本文旨在探讨标准HAART方案对不同非传染性hiv相关合并症(代谢、心血管、骨骼和肾脏疾病)的影响，以便根据个体临床情况提供最合适的抗逆转录病毒联合治疗工具。替代抗逆转录病毒策略的临床经验，避免核苷逆转录酶抑制剂的毒性和涉及新的抗逆转录病毒类，将进行回顾，以获得对未来前景的概述。

引用次数: 6

Immune reconstitution inflammatory syndrome in HIV-positive patients: a relatively new and not fully understood phenomenon 艾滋病毒阳性患者的免疫重建炎症综合征:一个相对较新的和尚未完全了解的现象

HIV therapy

Pub Date : 2010-10-25 DOI: 10.2217/HIV.10.45

G. Arendt, T. Nolting

The article describes the immune reconstitution inflammatory syndrome in HIV-positive patients as a phenomenon detected in recent years as a consequence of HAART initiation in patients with a severely compromised immune system and rapid improvement under HAART. Pathophysiology, clinical presentation and therapeutic options are discussed.

这篇文章描述了hiv阳性患者的免疫重建炎症综合征是近年来发现的一种现象，这是由于免疫系统严重受损的患者开始HAART治疗并在HAART治疗下迅速改善的结果。病理生理，临床表现和治疗方案进行了讨论。

引用次数: 1

HIV treatment in the criminal justice system 刑事司法系统中的艾滋病毒治疗

HIV therapy

Pub Date : 2010-10-25 DOI: 10.2217/HIV.10.43

M. Milloy, E. Wood

The advent of HAART has resulted in a dramatic decline in HIV-related morbidity and mortality among those accessing HIV treatment [1]. Fortunately, efforts to simplify regimens and scale up treatment systems have led to individuals being engaged in treatment in numbers and locales that were unimaginable just 10 years ago. Still, some seropositive populations have not benefited equally from advancements in HIV treatment. Studies of HIV-seropositive individuals who use injection drugs (IDU) on HAART confirm that adherent individuals can derive similar benefits as adherent individuals from other risk groups [2]. Nevertheless, coverage of HAART among IDU remains low, not only in areas such as the Russian Federation and other countries of the former Soviet Union and China, where a substantial and increasing proportion of new infections are linked to injection drug use, but also in settings with advanced healthcare systems [3]. Once on HAART, HIVseropositive IDU often achieve lower levels of adherence and are more likely to prematurely discontinue therapy [4,5]. As a result of the individual and, likely, community [6] benefits of attracting and maintaining IDU on HAART, there is an urgent need to identify and remove barriers to access and adherence to HAART among IDU [7].

高效抗逆转录病毒疗法的出现使得获得HIV治疗的人群中与HIV相关的发病率和死亡率显著下降[1]。幸运的是，简化治疗方案和扩大治疗系统的努力已经使参与治疗的个人数量和地点达到了10年前无法想象的水平。尽管如此，一些血清阳性人群并没有从艾滋病毒治疗的进步中平等受益。对在HAART治疗中使用注射药物(IDU)的hiv血清阳性个体的研究证实，坚持治疗的个体可以获得与其他风险群体中坚持治疗的个体相似的益处[2]。然而，在IDU中，HAART的覆盖率仍然很低，不仅在俄罗斯联邦和前苏联其他国家和中国等地区，新感染的大量增加比例与注射吸毒有关，而且在具有先进卫生保健系统的环境中也是如此[3]。一旦接受HAART治疗，hiv血清阳性IDU的依从性往往较低，并且更有可能过早停止治疗[4,5]。由于吸引和维持注射吸毒者接受HAART治疗对个人和社区[6]都有好处，因此迫切需要确定并消除注射吸毒者获得和坚持HAART治疗的障碍[7]。

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引用次数: 0

Clinical use of raltegravir: a review 雷替重力韦的临床应用综述

HIV therapy

Pub Date : 2010-10-25 DOI: 10.2217/HIV.10.38

E. Nunes, Marília Santini de Oliveira, B. Grinsztejn

In the last 5 years there have been important achievements in the field of HIV therapy with the availability of new classes of antiretrovirals together with a new generation of old classes. Among them, the development of raltegravir, the first commercially available component of integrase inhibitors, brought an extraordinary improvement in salvage therapy for HIV-infected patients, allowing for virologic suppression even in multi-experienced subjects, who until recently had limited treatment options. It was subsequently approved for initial treatment combined with a nucleoside/nucleotide backbone, and also became an interesting option for naive HIV-infected populations. Its unique characteristics, the limited potential for significant pharmacokinetic interactions with other drugs and excellent safety profile have increased interest in its use in different settings.

在过去的5年里，在艾滋病毒治疗领域取得了重要的成就，新类别的抗逆转录病毒药物以及新一代的旧类别。其中，整合酶抑制剂的第一个商业化成分——雷替格拉韦的开发，为hiv感染患者的挽救治疗带来了非凡的改善，即使是在有多种治疗经验的受试者中，也可以进行病毒学抑制，这些患者直到最近才有有限的治疗选择。随后，它被批准与核苷/核苷酸主干联合用于初始治疗，也成为初次感染hiv的人群的一个有趣的选择。其独特的特性，与其他药物的显著药代动力学相互作用的有限潜力和良好的安全性，增加了人们对其在不同环境下使用的兴趣。

引用次数: 3

HIV treatment in US prisons. 美国监狱的艾滋病治疗。

HIV therapy

Pub Date : 2010-09-03 DOI: 10.2217/hiv.10.35

Sarah E Wakeman, Josiah D Rich

Arguably one of the most marginalized populations in our society, prisoners bear a disproportionate burden of infectious diseases, particularly HIV. In addition, groups known to be at an inordinately higher risk of HIV, including minorities, the addicted, the mentally ill and the impoverished are overrepresented among incarcerated populations. This concentration of HIV among groups that have been historically difficult to reach, with limited intersections with healthcare, provides an opportunity for testing, diagnosis, treatment, linkage to care and prevention. Providing HIV care within correctional facilities poses unique challenges. Barriers to confidentiality, access to medication and prior records, and lack of comprehensive discharge planning can serve as obstacles to providing optimal care. This article discusses the public health implications and importance of providing HIV care to prisoners, and also discusses the practicalities of working within an environment that poses particular barriers to care.

囚犯可以说是我们社会中最边缘化的人群之一，他们承受着不成比例的传染病负担，特别是艾滋病毒。此外，已知感染艾滋病毒的风险极高的群体，包括少数民族、吸毒者、精神病患者和贫困人口，在监禁人口中所占比例过高。艾滋病毒集中在历史上难以接触到的群体中，与医疗保健的交集有限，这为检测、诊断、治疗以及与护理和预防的联系提供了机会。在惩教设施内提供艾滋病毒护理面临着独特的挑战。保密、获取药物和既往记录方面的障碍，以及缺乏全面的出院计划，都可能成为提供最佳护理的障碍。本文讨论了向囚犯提供艾滋病毒护理的公共卫生影响和重要性，并讨论了在对护理构成特别障碍的环境中工作的可行性。

引用次数: 24

Recent developments in HIV-related kidney disease. hiv相关肾脏疾病的最新进展。

HIV therapy

Pub Date : 2010-09-01 DOI: 10.2217/hiv.10.42

Michelle M Estrella, Derek M Fine, Mohamed G Atta

Although kidney disease has been a recognized complication of HIV infection since the beginning of the HIV epidemic, its epidemiology, underlying causes and treatment have evolved in developed countries where HAART has been widely available. HIV-associated nephropathy and HIV immune complex-mediated kidney disease were the prominent renal diagnoses in the earlier period of the HIV epidemic. While HIV immune complex-mediated kidney disease remains a common finding among HIV-infected individuals with kidney disease, the incidence of HIV-associated nephropathy has been diminishing in developed countries. The role of the metabolic effects of long-term HAART exposure and nephrotoxicity of certain antiretroviral medications on the development and progression of chronic kidney disease is now of increasing concern. The long-term clinical implications of acute kidney injury among HIV-infected persons are increasingly recognized. Kidney disease in HIV-infected persons continues to be a major risk factor for morbidity and mortality in this patient population; therefore, early recognition and treatment of kidney disease are imperative in lessening the impact of kidney disease on the health of HIV-infected individuals. This review focuses on recent developments and ongoing challenges in the understanding, diagnosis and management of HIV-related kidney disease.

尽管自艾滋病毒开始流行以来，肾脏疾病一直是公认的艾滋病毒感染并发症，但在HAART已广泛应用的发达国家，其流行病学、根本原因和治疗方法已经发生了变化。HIV相关肾病和HIV免疫复合物介导的肾病是HIV流行早期突出的肾脏诊断。虽然艾滋病毒免疫复合物介导的肾病在艾滋病毒感染的肾病患者中仍然是一种常见的发现，但在发达国家，艾滋病毒相关肾病的发病率一直在下降。长期HAART暴露的代谢效应和某些抗逆转录病毒药物的肾毒性在慢性肾脏疾病的发生和进展中的作用现在越来越受到关注。艾滋病毒感染者急性肾损伤的长期临床意义日益被认识到。艾滋病毒感染者的肾脏疾病仍然是这一患者群体发病和死亡的主要危险因素;因此，早期识别和治疗肾脏疾病对于减轻肾脏疾病对hiv感染者健康的影响至关重要。本文综述了hiv相关肾脏疾病的理解、诊断和管理方面的最新进展和面临的挑战。

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引用次数: 22

Origin of HIV/AIDS and risk for ongoing zoonotic transmissions from nonhuman primates to humans 艾滋病毒/艾滋病的起源和非人类灵长类动物向人类持续传播的人畜共患疾病的风险

HIV therapy

Pub Date : 2010-07-07 DOI: 10.2217/HIV.10.33

M. Peeters, S. A. Mundeke, E. M. Ngole, E. Delaporte

Origin & history of the HIV/ AIDS epidemic HIV/AIDS ranks as one of the most important infectious diseases to have emerged in the past century and continues to be one of the most serious public health threats of the 21st cen‐ tury. AIDS was first recognized in the early 1980s and today, approximately 30 years later, more than 33 million people worldwide are infected with HIV and more than 25 million people have died from the disease. Similar to the majority of emerging infectious diseases, HIV/ AIDS is also of zoonotic origin and occurred when an established SIV switched from pri‐ mates into humans [1–3]. The closest simian relatives of HIV‐1 are SIVcpz in chimpanzees (Pan troglodytes troglodytes) and SIVgor in goril‐ las (Gorilla gorilla) from West Central Africa [4,5]. SIVsmm in sooty mangabeys (Cercocebus atys) from West Africa are the closest relatives of HIV‐2 [6,7]. Although the exact conditions and circumstances of cross‐species transmis‐ sion of SIVs from primates to humans remain unknown, human exposure to blood or other secretions of infected primates, through hunting and butchering of primate bushmeat, represents the most plausible source for human infection. In addition, bites and other injuries caused by primates kept as pet animals can favor a possible viral transmission.

艾滋病毒/艾滋病被列为上个世纪出现的最重要的传染病之一，并继续成为21世纪最严重的公共卫生威胁之一。艾滋病在1980年代初首次得到确认，今天，大约30年后，全世界有3 300多万人感染了艾滋病毒，2 500多万人死于这种疾病。与大多数新发传染病类似，艾滋病毒/艾滋病也是人畜共患病，当已确定的SIV从pri - mates切换到人类时发生[1-3]。与HIV - 1最近的类人猿近亲是黑猩猩(类人猿)中的SIVcpz和来自中非西部的大猩猩(大猩猩)中的SIVcpz[4,5]。西非黑白眉猴(Cercocebus atys)中的SIVsmm是HIV‐2的近亲[6,7]。虽然siv从灵长类动物向人类跨物种传播的确切条件和环境尚不清楚，但人类通过狩猎和屠宰灵长类动物的丛林肉而接触到受感染灵长类动物的血液或其他分泌物，是人类感染的最可能的来源。此外，被作为宠物饲养的灵长类动物所造成的咬伤和其他伤害可能有利于病毒传播。

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