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| HIV耐药的现状、挑战与应对 |
| Current status, challenge and response to HIV drug resistance |
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| DOI：10.3969/j.issn.1007-8134.2019.06.002 |
| 中文关键词: 人免疫缺陷病毒 耐药 病毒载量 监测 |
| 英文关键词: human immunodeficiency virus drug resistance viral load surveillance |
| 基金项目:国家传染病科技重大专项（2018ZX10721102-006） |
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| 中文摘要: |
| 近年来，全球HIV耐药毒株发生和流行的形势发生了显著变化，在高收入国家呈稳定或下降趋势，而在广大中低收入国家仍呈上升趋势。预计2030年全球将有3300万人终生接受抗病毒治疗，极易出现治疗疲劳，保持良好的依从性是现实的挑战，存在由于漏服药物致使耐药毒株出现和流行的巨大风险。为了有效应对耐药，应做到：①加强病毒载量监测以预防耐药发生，及时发现病毒反弹，在多个耐药突变出现前改善依从性或调整治疗方案，避免耐药突变积累。②改进基因型耐药检测方法，建立简便的即时检测方法，最好与病毒载量即时检测试剂联合应用。③加强对耐药毒株流行的监测，做好治疗前耐药、获得性耐药和耐药早期预警监测。④研究新型防治策略的耐药问题，包括暴露前后预防和急性期治疗的耐药发生规律。⑤建立可有效减少耐药的新型防治模式，优化治疗服务，确保药物供应不中断，最大限度保持治疗减少脱失，有效评估、促进和保持依从性。 |
| 英文摘要: |
| The occurrence and epidemiology of drug-resistant HIV strains have been significantly changed in recent years, showing a relative stable or decline trend in high-income countries, whereas upward in low- and middle-income countries. More than 33 million patients are estimated to receive lifelong antiretroviral therapy in the year of 2030. The treatment fatigue will be inevitable. How to maintain good compliance is a challenge in practice. The occurrence and transmission of drug-resistant HIV strains due to missed dose will be at considerable risk. To effectively control HIV drug resistance, the following measures should be taken:① strengthening the viral load surveillance, so as to prevent drug resistance: finding the viral rebound in time, modifying the compliance or revising the treatment regimen prior to the emergence of multiple drug resistance mutations and avoiding the accumulated mutation of drug resistance;② modifying genotype drug resistance test method: establishing convenient and immediate test methods and combining with the reagents used for real-time viral load assay; ③ strengthening the surveillance of drug-resistant strains and including pre-treatment drug resistance, acquired drug resistance and early warning surveillance;④ clarifying the drug resistance related with novel prevention strategies, including pre-exposure prophylaxis and treatment at acute phase; ⑤ establishing novel treatment model minimizing drug resistance, optimizing treatment services, supplying drugs continually, maintaining the follow-ups, reducing drop-outs and effectively evaluating, promoting and maintaining the compliance. |
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