Author/Editor		Perrin, Luc
Title		When to start antiviral treatment and what with
Translated title		Kdaj naj začnemo protivirusno zdravljenje in s čim
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 36, št. Suppl
Publication year		1997
Volume		str. 179-85
Language		eng
Abstract		In recent years, changes in therapeutic concepts have been driven by basic scientific findings which have clearly shown that HIV-1 replication is a continuous process from the start of the infection, and that lymphoid tissues are the main site of viral replication and storage. Another finding concerns the rapid development of viral resistant variants in patients treated with suboptimal therapy. These elements have driven changes in guidelines from treatment based on symptoms towards a more aggressive therapeutic approach which can be summarised as follows: treat early and hard with an antiviral regimen which completely inhibits viral replication. Results of recent clinical trials using triple therapy combining antiprotease and reverse transcriptase inhibitors show that decrease of viremia to levels lower than 200 HIV-1 RNA copies/ml is achievable in the great majority of drug naive patients and in most patients previously exposed to one reverse transcriptase inhibitor. It is much more difficult to achieve control of viral replication in patients pretreated with suboptimal therapy for years (suboptimal treatment was the only possibility in the past). Compliance is also a major issue since most of the antiviral drugs have a short half life; poor compliance is followed by the emergence of a resistant virus. Thus, the definition of a clear strategy before initiation of treatment and patient commitment to treatment are mandatory for longterm success.
Summary		V zadnjih nekaj letih so znanstvena dognanja, ki so jasno pokazala, da razmnoževanje HIV poteka neprekinjeno od samega začetka okužbe s HIV in da so limfoidna tkiva glavno mesto razmnoževanja in skladiščenja virusa, povzročila spremembe v načinu zdravljenja okuženih bolnikov. Ugotovljeno je bilo tudi, da se pri suboptimalnem zdravljenju prav kmalu pojavijo odporne različice virusa. Smernice za zdravljenje so se torej spremenile-od simptomatskega zdravljenja v smeri bolj agresivnega pristopa: zdravljenje zdaj pričnemo zgodaj in zdravimo intenzivno z režimom, ki razmnoževanje virusa popolnoma zavre. Rezultati novejših kliničnih študij z uporabo trotirnega zdravljenja z uporabo antiproteaz in zaviralcev reverzne transkriptaze kažejo, da lahko pri veliki večini bolnikov, ki pred tem niso bili zdravljeni, in pri večini bolnikov, ki so bili zdravljeni z enim zaviralcem reverzne transkriptaze, dosežemo zmanjšanje vsebnosti virusa v krvi na manj kot 200 HIV- 1-RNA-kopij na mililiter. Veliko teže pa nadziramo razmnoževanje virusa pri bolnikih, ki so bili pred tem več let zdravljeni s suboptimalnim zdravljenjem (kar pa je bila v preteklosti edina možnost). Tudi sodelovanje bolnikov je pomembno za uspeh zdravljenja, saj ima večina protivirusnih zdravil kratek razpolovni čas in lahko nesodelovanje bolnikov pri zdravljenju omogoči pojav odpornega virusa. Zato sta opredelitev jasne strategije še pred začetkom zdravljenja in predanost bolnika zdravljenju obvezni za dolgoročen uspeh zdravljenja.
Descriptors		HIV INFECTIONS HIV-1 VIRUS REPLICATION