艾滋病毒-1蛋白酶抑制剂. 对临床医生的一篇评论
S G Deeks1, M Smith, M Holodniy
1University of California, San Francisco, USA.
JAMA
|January 8, 1997
概括
蛋白酶抑制剂 (PI) 对于人类免疫缺陷病毒 (HIV) 治疗至关重要,可降低病毒载量和增加CD4+计数. 对PI的患者选择需要仔细考虑疗效,毒性和成本.
科学领域:
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
- 病毒学 病毒学
背景情况:
- 人类免疫缺陷病毒 (HIV) 感染管理已经被蛋白酶抑制剂 (PI) 改变.
- 有四种PI可供选择:萨基纳维尔甲酸盐,利托纳维尔,印尼纳维尔硫酸盐和内尔菲纳维尔甲酸盐.
- 没有可用的比较研究,需要对现有数据进行评估.
研究的目的:
- 评估有关HIV特定蛋白酶抑制剂 (PI) 的现有数据.
- 帮助临床医生和患者选择适当的艾滋病毒治疗.
- 提供PI疗效,耐药性和成本的概述.
主要方法:
- 对同行评审出版物的系统审查.
- 包括来自国家和国际会议的摘要.
- 分析到1996年9月的产品注册信息.
主要成果:
- 里托纳维尔,印纳维尔和内尔菲纳维尔可以达到可持续的蛋白酶抑制血清水平;萨基纳维尔可能无法做到这一点.
- 同样的病毒载量减少和CD4+淋巴细胞增加观察到与利托纳维尔,印纳维尔和内尔菲纳维尔;较小的效果与萨基纳维尔.
- 在安慰剂控制的研究中,PI治疗表明减少了艾滋病毒疾病进展和死亡率;注意到基因型耐药性和显著的成本.
结论:
- 蛋白酶抑制剂对于艾滋病毒治疗至关重要,理想情况下与逆转录酶抑制剂一起使用.
- 个性化PI选择是必不可少的,考虑到活性,毒性,剂量,相互作用和成本.
- 虽然耐药性发展,PIs可以通过延迟疾病进展和改善生活质量而具有成本效益.
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