- 期刊
人類免疫缺乏病毒的雞尾酒療法
Update on Highly Active Anti-retroviral Therapy for Human Immunodeficiency Virus-1 Infection
摘要
愛滋病是一個慢性、免疫系統感染的疾病，病人需要終生服用強效抗病毒混合藥物(Highly Active Anti-Retroviral Therapy; HAART)，即俗稱雞尾酒藥物(cocktail therapy)。醫師、護理師、藥師，甚至病人自己，都必須知道最新的藥物資訊，最有效、安全的藥物組合。如何選擇適合每一位感染者的雞尾酒處方，從開始治療的時機，那一種處方，服藥順從性的諮商，臨床的追蹤，尤有甚者，是否需要病毒抗藥性檢驗報告等，在在都挑戰醫療照顧者的能力與智慧。歐、美及國內，都有制訂相關的指引，並且定期更新，以供參考。國內衛生署疾病管制局2005年也邀集許多專家，以他們實際的臨床經驗，並且參考歐、美國家的指引，制訂我國愛滋病毒治療指引。其中也建議孕婦、小兒感染者抗病毒藥物處方，個別藥物注意事項、相關副作用等，提供醫師同仁參考。國內目前面對新的挑戰，在於雖然有雞尾酒藥物治療，使其死亡率大大的降低，但是國內、國外的專家也已發現病毒抗藥性，陸續出現。大部份因為治療失敗，病毒產生抗藥性。但也有文獻報告指出，許多即使從未使用雞尾酒藥物治療的病患，體內的愛滋病病毒已經產生抗藥性。新一代的抗病毒藥物，例如darunavir、tipanavir，甚至新作用機轉抗病毒藥物，如接受器結合抑制劑enfuvirtide和結合酶抑制劑Raltegravir，對未來愛滋病的治療及控制，寄予很大的期望。
並列摘要
The treatment of HIV-infected patients is complex. Health care workers and even patients should be aware of the latest data combined with knowledge of the individual combination of antiretroviral therapy (ARV) of each patient. Initiating therapy, using new highly active anti-retroviral therapy in the context of drug resistance, and managing ART in co-infected patients are three areas that pose special challenges for HCW who care for HIV infected patients. ART should be initiated with care. Resistance testing before the initiation of therapy is recommended to devise the most effective regimen. Current guidelines on when to initiate therapy, along with the recommendations for preferred initial regimens, will be reviewed in light of the latest data. Side effects, dosing frequency and pill burden, food restrictions, and drug interactions are important factors that may influence adherence. For minority patients, there is an increased incidence of side effects with certain ARV. In addition, pregnancy potential should be taken into account when choosing ARV for women. Despite these considerations, proper selection and monitoring of patients starting ART can help to minimize toxicities and improve adherence of ARV, thus the chances of success. Treatment options are further limited when drug resistance is present. This may be due to either treatment failure or the transmission of resistant virus. Although the continuing development of new ARV provides options for patients who harbor multidrug-resistant virus, studies with enfuvirtide and tipranavir have shown that newer ARV must be combined with other active ARV in order for treatment regimens to achieve maximal efficacy. The earlier use of new agents has been shown to be effective in preventing the development of further resistance. Understanding the resistance profiles of current drugs as well as new drugs in the pipeline will help to determine how regimens may be sequenced.