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| 1行目: | 1行目: | ||
| − | {{ | + | {{Floating_Menu}} |
==疫学== | ==疫学== | ||
| 45行目: | 45行目: | ||
#≧4 doses/week - anal sex | #≧4 doses/week - anal sex | ||
| − | ===daily=== | + | ====daily PrEP==== |
*1 tablet/day | *1 tablet/day | ||
*effective for anal sex 1 day after of commencement | *effective for anal sex 1 day after of commencement | ||
*effective for vaginal sex 7 days after of commencement | *effective for vaginal sex 7 days after of commencement | ||
| − | ===event-based=== | + | ====event-based PrEP==== |
*2 tabltes at 2-24 hours before anal sex + 1 tablet 24-48 hours after the sex | *2 tabltes at 2-24 hours before anal sex + 1 tablet 24-48 hours after the sex | ||
*not effective against vaginal sex | *not effective against vaginal sex | ||
| − | ===4 doses/week=== | + | ====4 doses/week==== |
| − | ===how to stop=== | + | ====how to stop==== |
*have to continue for a certain duration after the last sex | *have to continue for a certain duration after the last sex | ||
* | * | ||
* | * | ||
| − | ===monitoring=== | + | ====monitoring==== |
*test renal function every 3 mo | *test renal function every 3 mo | ||
**annually for eGFR>90 or <40y/o | **annually for eGFR>90 or <40y/o | ||
| 69行目: | 69行目: | ||
*offer STIs screening | *offer STIs screening | ||
| − | ===contraindication=== | + | ====contraindication of PrEP==== |
*Renal dysfunction; eGFR<60 | *Renal dysfunction; eGFR<60 | ||
*Osteoprorosis | *Osteoprorosis | ||
*event-based dosing is option for contraindicated people | *event-based dosing is option for contraindicated people | ||
| − | ===clincal | + | ====clincal trials of PrEP==== |
*PROUD study | *PROUD study | ||
**86% reduction of HIV | **86% reduction of HIV | ||
*IMPACT study | *IMPACT study | ||
| + | |||
| + | ===Prevention of Mother to Child transmission (PMTCT)=== | ||
| + | *Primary prevention in women of childbearing age | ||
| + | *Voluntary counseling and testing (VCT) provided in prenatal care | ||
| + | *ART for PMTCT | ||
| + | |||
| + | ====WHO Consolidated Guidelines in 2021==== | ||
| + | *[https://www.who.int/publications/i/item/9789240031593 Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. 16 July 2021] | ||
| + | **refer to 'Chapter 3.4 Infant prophylaxis' on pp.91 (134th as PDF) | ||
| + | *Mother | ||
| + | **Urgently commence ART for all HIV-infected pregnant and post-partum women irrespective of time or viral load | ||
| + | *All Infants | ||
| + | **Daily AZT+NVP from 0d to 6w | ||
| + | *Breastfed infants of high risk | ||
| + | **Additional AZT+NVP or NVP alone from 6w to 12w | ||
| + | *Breastfed infants of mother under ART | ||
| + | **Additional daily NVP from 6w to 12w | ||
| + | *Replacement fed infants of mother under ART | ||
| + | **Additional daily NVP from 6w to 10-12w | ||
| + | |||
| + | ==WHO Clinical staging== | ||
| + | {{quote|content=[https://apps.who.int/iris/handle/10665/43699 WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children (2007)] | ||
| + | }} | ||
| + | |||
| + | {|class="wikitable" | ||
| + | |- | ||
| + | !style="width:4%"|Stage | ||
| + | !style="width:24%"|1<br>≈ CD4 500- | ||
| + | !style="width:24%"|2<br>≈ CD4 350-500 | ||
| + | !style="width:24%"|3<br>≈ CD4 200-350 | ||
| + | !style="width:24%"|4<br>≈ CD4 -200 | ||
| + | |- style="vertical-align:top" | ||
| + | !Skin | ||
| + | | | ||
| + | | | ||
| + | *Herpes zoster | ||
| + | *Papular pruritic eruptions | ||
| + | *Seborrheic dermatitis | ||
| + | *Fungal nail infections | ||
| + | | | ||
| + | | | ||
| + | *Herpes simplex infection (oral, genital) > 1 month | ||
| + | *[[Talaromycosis|Talaromycosis]] (Asia only) | ||
| + | |- style="vertical-align:top" | ||
| + | !Oral<br>GI tract | ||
| + | | | ||
| + | | | ||
| + | *Angular cheilitis | ||
| + | *Oral ulcer, recurrent | ||
| + | | | ||
| + | *'''Oral''' candidiasis | ||
| + | *Oral hairy leukoplakia (EBV-associated) | ||
| + | *Acute necrotizing ulcerative stomatitis/gingivitis/periodontitis | ||
| + | *Diarrhea > 1 month, unexplained | ||
| + | | | ||
| + | *'''Esophageal''' candidiasis | ||
| + | *Cryptosporidiasis, chronic | ||
| + | *Isosporiasis, chronic | ||
| + | |- style="vertical-align:top" | ||
| + | !Respiratory | ||
| + | | | ||
| + | | | ||
| + | *URIs, recurrent | ||
| + | | | ||
| + | *Bacterial LRIs | ||
| + | *Pulmonary TB, '''pluribacillary''' | ||
| + | | | ||
| + | *Severe bacterial LRIs, recurrent | ||
| + | *Pulmonary TB, '''paucibacillary''' | ||
| + | *Pneumocystis pneumonia (PcP) | ||
| + | |- style="vertical-align:top" | ||
| + | !Neurological | ||
| + | | | ||
| + | | | ||
| + | | | ||
| + | | | ||
| + | *CNS toxoplamosis (Toxoplasmoma) | ||
| + | *HIV encephalopathy | ||
| + | *CNS cryptococcal infection (Cryptococcoma) | ||
| + | *Progressive multifocal leukoencephalopathy | ||
| + | |- style="vertical-align:top" | ||
| + | !Systemic | ||
| + | | | ||
| + | *Asymptomatic | ||
| + | *Acute HIV infection | ||
| + | *Lymphadenopathy, persistent | ||
| + | | | ||
| + | *Weight loss '''<10%''', unexplained | ||
| + | | | ||
| + | *Weight loss '''>10%''', unexplained | ||
| + | *Fever > 1 month, unexplained | ||
| + | *Sever bacterial infections (LRI, bone/joint infections, meningitis) | ||
| + | *Anemia < 8g/dL of Hb, unexplained | ||
| + | *Thrombocytopenia < 50<math>\times</math>10<math>^9</math>/L, unexplained | ||
| + | | | ||
| + | *HIV wasting syndrome | ||
| + | *Extrapulmonary TB | ||
| + | *Cytomegalovirus infection | ||
| + | *Non-typhoidal salmonellosis (NTS), recurrent | ||
| + | *[[Coccidioidomycosis|Coccidioidomycosis]] (America only) | ||
| + | *[[Histoplasmosis|Histoplasmosis]] | ||
| + | *Atypical disseminated leishmaniasis | ||
| + | *HIV-associated nephrophathy | ||
| + | *HIV-associated cardiomyopathy | ||
| + | |- style="vertical-align:top" | ||
| + | !Malignancy | ||
| + | | | ||
| + | | | ||
| + | | | ||
| + | | | ||
| + | *Kaposi's sarcoma | ||
| + | *Lymphoma | ||
| + | *Cervical carcinoma | ||
| + | *HIV-associated solid tumors | ||
| + | |} | ||
==Treatment== | ==Treatment== | ||
| 243行目: | 358行目: | ||
!colspan="3"|NRTI | !colspan="3"|NRTI | ||
|- | |- | ||
| − | + | !colspan="3" style="background-color:gold"|Tenofovir<br>TDF | |
|- | |- | ||
|colspan="3"|Tenofovir alafenamide fumarate<br>TAF | |colspan="3"|Tenofovir alafenamide fumarate<br>TAF | ||
|- | |- | ||
| − | + | !colspan="3" style="background-color:gold"|Lamivudine<br>3TC | |
|- | |- | ||
|colspan="3"|Zidovudine<br>AZT | |colspan="3"|Zidovudine<br>AZT | ||
| 258行目: | 373行目: | ||
|- | |- | ||
|Efavirenz<br>EFV | |Efavirenz<br>EFV | ||
| − | |Dolutegravir<br>DTG | + | !style="background-color:gold"|Dolutegravir<br>DTG |
|Lopinavir-Ritonavir<br>LPV-r | |Lopinavir-Ritonavir<br>LPV-r | ||
|- | |- | ||
| 273行目: | 388行目: | ||
!colspan="3"|NRTI | !colspan="3"|NRTI | ||
|- | |- | ||
| − | + | !colspan="3" style="background-color:gold"|Tenofovir<br>TDF | |
|- | |- | ||
|colspan="3"|Tenofovir alafenamide fumarate<br>TAF | |colspan="3"|Tenofovir alafenamide fumarate<br>TAF | ||
|- | |- | ||
| − | + | !colspan="3" style="background-color:gold"|Lamivudine<br>3TC | |
|- | |- | ||
|colspan="3"|Zidovudine<br>AZT | |colspan="3"|Zidovudine<br>AZT | ||
| 287行目: | 402行目: | ||
!style="width:33.3%"|PI | !style="width:33.3%"|PI | ||
|- | |- | ||
| − | |Efavirenz<br>EFV | + | !style="background-color:gold"|Efavirenz<br>EFV 400mg |
|Dolutegravir<br>DTG | |Dolutegravir<br>DTG | ||
|Lopinavir-Ritonavir<br>LPV-r | |Lopinavir-Ritonavir<br>LPV-r | ||
| 329行目: | 444行目: | ||
<div style="clear:both;"></div> | <div style="clear:both;"></div> | ||
| − | ====Children=== | + | ====Children==== |
<div style="float:left; padding-right:1em;"> | <div style="float:left; padding-right:1em;"> | ||
{|class="wikitable" style="width:400px; text-align:center" | {|class="wikitable" style="width:400px; text-align:center" | ||
| 340行目: | 455行目: | ||
|colspan="3"|Tenofovir alafenamide fumarate<br>TAF | |colspan="3"|Tenofovir alafenamide fumarate<br>TAF | ||
|- | |- | ||
| − | + | !colspan="3" style="background-color:khaki"|Lamivudine<br>3TC | |
|- | |- | ||
|colspan="3"|Zidovudine<br>AZT | |colspan="3"|Zidovudine<br>AZT | ||
|- | |- | ||
| − | + | !colspan="3" style="background-color:khaki"|Abacavir<br>ABC | |
|- | |- | ||
!style="width:33.3%"|NNRTI | !style="width:33.3%"|NNRTI | ||
| 351行目: | 466行目: | ||
|- | |- | ||
|Efavirenz<br>EFV | |Efavirenz<br>EFV | ||
| − | |Dolutegravir<br>DTG | + | !style="background-color:khaki"|Dolutegravir<br>DTG |
|Lopinavir-Ritonavir<br>LPV-r | |Lopinavir-Ritonavir<br>LPV-r | ||
|- | |- | ||
| 370行目: | 485行目: | ||
|colspan="3"|Tenofovir alafenamide fumarate<br>TAF | |colspan="3"|Tenofovir alafenamide fumarate<br>TAF | ||
|- | |- | ||
| − | + | !colspan="3" style="background-color:khaki"|Lamivudine<br>3TC | |
|- | |- | ||
|colspan="3"|Zidovudine<br>AZT | |colspan="3"|Zidovudine<br>AZT | ||
|- | |- | ||
| − | + | !colspan="3" style="background-color:khaki"|Abacavir<br>ABC | |
|- | |- | ||
!style="width:33.3%"|NNRTI | !style="width:33.3%"|NNRTI | ||
| 382行目: | 497行目: | ||
|Efavirenz<br>EFV | |Efavirenz<br>EFV | ||
|Dolutegravir<br>DTG | |Dolutegravir<br>DTG | ||
| − | |Lopinavir-Ritonavir<br>LPV-r | + | !style="background-color:khaki"|Lopinavir-Ritonavir<br>LPV-r |
|- | |- | ||
|Nevirapine<br>NVP | |Nevirapine<br>NVP | ||
| 422行目: | 537行目: | ||
<div style="clear:both;"></div> | <div style="clear:both;"></div> | ||
| − | ====Neonates=== | + | ====Neonates==== |
<div style="float:left; padding-right:1em;"> | <div style="float:left; padding-right:1em;"> | ||
{|class="wikitable" style="width:400px; text-align:center" | {|class="wikitable" style="width:400px; text-align:center" | ||
| 433行目: | 548行目: | ||
|colspan="3"|Tenofovir alafenamide fumarate<br>TAF | |colspan="3"|Tenofovir alafenamide fumarate<br>TAF | ||
|- | |- | ||
| − | + | !colspan="3" style="background-color:yellow"|Lamivudine<br>3TC | |
|- | |- | ||
| − | + | !colspan="3" style="background-color:yellow"|Zidovudine<br>AZT | |
|- | |- | ||
|colspan="3"|Abacavir<br>ABC | |colspan="3"|Abacavir<br>ABC | ||
| 448行目: | 563行目: | ||
|- | |- | ||
|Nevirapine<br>NVP | |Nevirapine<br>NVP | ||
| − | |Raltegravir<br>RAL | + | !style="background-color:yellow"|Raltegravir<br>RAL |
|Atazanavir<br>ATV-r | |Atazanavir<br>ATV-r | ||
|} | |} | ||
| 463行目: | 578行目: | ||
|colspan="3"|Tenofovir alafenamide fumarate<br>TAF | |colspan="3"|Tenofovir alafenamide fumarate<br>TAF | ||
|- | |- | ||
| − | + | !colspan="3" style="background-color:yellow"|Lamivudine<br>3TC | |
|- | |- | ||
| − | + | !colspan="3" style="background-color:yellow"|Zidovudine<br>AZT | |
|- | |- | ||
|colspan="3"|Abacavir<br>ABC | |colspan="3"|Abacavir<br>ABC | ||
| 477行目: | 592行目: | ||
|Lopinavir-Ritonavir<br>LPV-r | |Lopinavir-Ritonavir<br>LPV-r | ||
|- | |- | ||
| − | |Nevirapine<br>NVP | + | !style="background-color:yellow"|Nevirapine<br>NVP |
|Raltegravir<br>RAL | |Raltegravir<br>RAL | ||
|Atazanavir<br>ATV-r | |Atazanavir<br>ATV-r | ||
| 493行目: | 608行目: | ||
|colspan="3"|Tenofovir alafenamide fumarate<br>TAF | |colspan="3"|Tenofovir alafenamide fumarate<br>TAF | ||
|- | |- | ||
| − | + | !colspan="3" style="background-color:yellow"|Lamivudine<br>3TC | |
|- | |- | ||
| − | + | !colspan="3" style="background-color:yellow"|Zidovudine<br>AZT | |
|- | |- | ||
|colspan="3"|Abacavir<br>ABC | |colspan="3"|Abacavir<br>ABC | ||
| 505行目: | 620行目: | ||
|Efavirenz<br>EFV | |Efavirenz<br>EFV | ||
|Dolutegravir<br>DTG | |Dolutegravir<br>DTG | ||
| − | |Lopinavir-Ritonavir<br>LPV-r | + | !style="background-color:yellow"|Lopinavir-Ritonavir<br>LPV-r |
|- | |- | ||
|Nevirapine<br>NVP | |Nevirapine<br>NVP | ||
| 617行目: | 732行目: | ||
*治療効果判定にはviral load | *治療効果判定にはviral load | ||
*CD4 countは初診時には有用だがフォローアップには無用；viral loadが大事 | *CD4 countは初診時には有用だがフォローアップには無用；viral loadが大事 | ||
| + | |||
| + | ==Additional materials of HIV== | ||
| + | {{quote | ||
| + | |content=[https://www.nature.com/collections/mghkkdjlgx Nature Materials in HIV research] | ||
| + | |||
| + | https://www.nature.com/collections/mghkkdjlgx | ||
| + | }} | ||
2023年9月14日 (木) 15:04時点における最新版
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目次
疫学
マクロな疫学
AIDS発症はHICではPcPが最頻，LMICでは結核が最頻
ミクロな疫学
ウイルス学
細胞感染
- CD4 receptorに接合attach
- CCR5/CXCR4に結合 ←chemokine receptor antagonist
- 細胞膜融合
- viral RNAの逆転写（細胞質） ←RTase inhibitor;NRTI, NNRTI
- proviral RNA integration（核内） ←integrase inhibitor
- ウイルスタンパクのポリペプチドへの分解と再構成（細胞質） ←protease inhibitor
HIV-1 typing
- Group M
- clade: A,B,C,...,K,CRFs
- CRF=circulating recombinant forms
- clade: A,B,C,...,K,CRFs
- Group N
- Group O
- Group P
検査
予防
- Frequent testing
- Treatment as prevention; U=U
- PrPE
- PEP within 72 hrs
- Condom
PrEP
- 1 pill "Truvada"
- Tenefovir + Emtricitabine
- inhibits reverse transcriptase
- 20 USD/month
- >86% reduction
- high concentration in genital issues
- Administration options
- daily - for anal and vaginal sex
- event-based - for anal sex
- ≧4 doses/week - anal sex
daily PrEP
- 1 tablet/day
- effective for anal sex 1 day after of commencement
- effective for vaginal sex 7 days after of commencement
event-based PrEP
- 2 tabltes at 2-24 hours before anal sex + 1 tablet 24-48 hours after the sex
- not effective against vaginal sex
4 doses/week
how to stop
- have to continue for a certain duration after the last sex
monitoring
- test renal function every 3 mo
- annually for eGFR>90 or <40y/o
- check bone history including FRAX score
- test HIV, hepB, Urea, Electrolytes
- U/A
- offer STIs screening
contraindication of PrEP
- Renal dysfunction; eGFR<60
- Osteoprorosis
- event-based dosing is option for contraindicated people
clincal trials of PrEP
- PROUD study
- 86% reduction of HIV
- IMPACT study
Prevention of Mother to Child transmission (PMTCT)
- Primary prevention in women of childbearing age
- Voluntary counseling and testing (VCT) provided in prenatal care
- ART for PMTCT
WHO Consolidated Guidelines in 2021
- Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach. 16 July 2021
- refer to 'Chapter 3.4 Infant prophylaxis' on pp.91 (134th as PDF)
- Mother
- Urgently commence ART for all HIV-infected pregnant and post-partum women irrespective of time or viral load
- All Infants
- Daily AZT+NVP from 0d to 6w
- Breastfed infants of high risk
- Additional AZT+NVP or NVP alone from 6w to 12w
- Breastfed infants of mother under ART
- Additional daily NVP from 6w to 12w
- Replacement fed infants of mother under ART
- Additional daily NVP from 6w to 10-12w
WHO Clinical staging
| Stage | 1 ≈ CD4 500- |
2 ≈ CD4 350-500 |
3 ≈ CD4 200-350 |
4 ≈ CD4 -200 |
|---|---|---|---|---|
| Skin |
|
| ||
| Oral GI tract |
|
|
| |
| Respiratory |
|
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| |
| Neurological |
| |||
| Systemic |
|
|
|
|
| Malignancy |
|
Treatment
|
WHO｜Update of recommendations on first- and second-line antiretroviral regimens - Policy brief |
|
The Lighthouse - A Centre for Comprehensive HIV/AIDS Treatment and Care in Malawi |
原則
- 異なる2クラスで異なる3剤によるcombination Txが必須
- 生涯治療
Combination
- NRTI - Nucleoside reverse transcriptase inhibitor
- NNRTI - Non-Nucleoside reverse transcriptase inhibitor
- PI - Protease inhibitor
- INI - Integrase inhibitor
NRTI + NRTI + {NNRTI or INI or PI}
scheme
|
NRTI | |||
|---|---|---|---|
|
Tenofovir |
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| Tenofovir alafenamide fumarate TAF |
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| Lamivudine 3TC |
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|
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| Emtricitabine FTC | |||
| Zidovudine AZT |
|
| |
| Abacavir ABC |
|
| |
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NNRTI | ||
|---|---|---|
|
Efavirenz |
|
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| Nevirapine NVP |
|
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INI | ||
|---|---|---|
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Dolutegravir |
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| Raltegravir RAL |
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PI | ||
|---|---|---|
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Lopinavir-Ritonavir |
|
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| Atazanavir ATV-r |
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WHO Guideline 2019
Adults and adolescents
| NRTI | ||
|---|---|---|
| Tenofovir TDF | ||
| Tenofovir alafenamide fumarate TAF | ||
| Lamivudine 3TC | ||
| Zidovudine AZT | ||
| Abacavir ABC | ||
| NNRTI | INI | PI |
| Efavirenz EFV |
Dolutegravir DTG |
Lopinavir-Ritonavir LPV-r |
| Nevirapine NVP |
Raltegravir RAL |
Atazanavir ATV-r |
| NRTI | ||
|---|---|---|
| Tenofovir TDF | ||
| Tenofovir alafenamide fumarate TAF | ||
| Lamivudine 3TC | ||
| Zidovudine AZT | ||
| Abacavir ABC | ||
| NNRTI | INI | PI |
| Efavirenz EFV 400mg |
Dolutegravir DTG |
Lopinavir-Ritonavir LPV-r |
| Nevirapine NVP |
Raltegravir RAL |
Atazanavir ATV-r |
| NRTI | ||
|---|---|---|
| Tenofovir TDF | ||
| Tenofovir alafenamide fumarate TAF | ||
| Lamivudine 3TC | ||
| Zidovudine AZT | ||
| Abacavir ABC | ||
| NNRTI | INI | PI |
| Efavirenz EFV |
Dolutegravir DTG |
Lopinavir-Ritonavir LPV-r |
| Nevirapine NVP |
Raltegravir RAL |
Atazanavir ATV-r |
Children
| NRTI | ||
|---|---|---|
| Tenofovir TDF | ||
| Tenofovir alafenamide fumarate TAF | ||
| Lamivudine 3TC | ||
| Zidovudine AZT | ||
| Abacavir ABC | ||
| NNRTI | INI | PI |
| Efavirenz EFV |
Dolutegravir DTG |
Lopinavir-Ritonavir LPV-r |
| Nevirapine NVP |
Raltegravir RAL |
Atazanavir ATV-r |
| NRTI | ||
|---|---|---|
| Tenofovir TDF | ||
| Tenofovir alafenamide fumarate TAF | ||
| Lamivudine 3TC | ||
| Zidovudine AZT | ||
| Abacavir ABC | ||
| NNRTI | INI | PI |
| Efavirenz EFV |
Dolutegravir DTG |
Lopinavir-Ritonavir LPV-r |
| Nevirapine NVP |
Raltegravir RAL |
Atazanavir ATV-r |
| NRTI | ||
|---|---|---|
| Tenofovir TDF | ||
| Tenofovir alafenamide fumarate TAF | ||
| Lamivudine 3TC | ||
| Zidovudine AZT | ||
| Abacavir ABC | ||
| NNRTI | INI | PI |
| Efavirenz EFV |
Dolutegravir DTG |
Lopinavir-Ritonavir LPV-r |
| Nevirapine NVP |
Raltegravir RAL |
Atazanavir ATV-r |
Neonates
| NRTI | ||
|---|---|---|
| Tenofovir TDF | ||
| Tenofovir alafenamide fumarate TAF | ||
| Lamivudine 3TC | ||
| Zidovudine AZT | ||
| Abacavir ABC | ||
| NNRTI | INI | PI |
| Efavirenz EFV |
Dolutegravir DTG |
Lopinavir-Ritonavir LPV-r |
| Nevirapine NVP |
Raltegravir RAL |
Atazanavir ATV-r |
| NRTI | ||
|---|---|---|
| Tenofovir TDF | ||
| Tenofovir alafenamide fumarate TAF | ||
| Lamivudine 3TC | ||
| Zidovudine AZT | ||
| Abacavir ABC | ||
| NNRTI | INI | PI |
| Efavirenz EFV |
Dolutegravir DTG |
Lopinavir-Ritonavir LPV-r |
| Nevirapine NVP |
Raltegravir RAL |
Atazanavir ATV-r |
| NRTI | ||
|---|---|---|
| Tenofovir TDF | ||
| Tenofovir alafenamide fumarate TAF | ||
| Lamivudine 3TC | ||
| Zidovudine AZT | ||
| Abacavir ABC | ||
| NNRTI | INI | PI |
| Efavirenz EFV |
Dolutegravir DTG |
Lopinavir-Ritonavir LPV-r |
| Nevirapine NVP |
Raltegravir RAL |
Atazanavir ATV-r |
NRTIs
- Nucleoside analogue 競合的にNRTを阻害する
- Tenofovir TDF 最重要
- Once daily
- hep Bにも有効
- 腎毒性；尿細管障害
- 尿dip stickでモニター
- 骨塩減少
- 小児には使いにくい
- Tenofovir alafenamide fumarate TAF；新しいプロドラッグ
- Zidovudine AZT
- 最初のARV in 1987
- 骨髄抑制；大球性貧血
- Twice daily
- Lamivudine 3TC /Emtricitabine FTC
- Lamivudine 3TC
- すべてのレジメンでbackbone
- high tolerance
- hep Bにも有効
- 耐性閾値が低い
- Emtricitabnine FTC
- 3TCのlong-acting type
- Lamivudine 3TC
- Abacavir ABC
- 他薬intolerance時の代替
- 主として小児
- HLA-B5701陽性者でのfebrile hypersensitivity
- HLA-B5701陽性者はアフリカでは極めて稀
- 他薬intolerance時の代替
NNRTIs
- Efavirenz EFV
- Nevirapine NVP
- Efavirenz EFV
- NNRTIの1st choice
- little interaction with Tb drugs
- dizzyness, insomnia, nightmare, depression, psychoses
- rash
- gynecomastia; 6% in Africa
- Nevirapine NVP
- あまり使われなくなった
- Rash→Stevens-Johnson
- 肝毒性
- 女性に多い
- CD4>250でリスク12倍
- HIV-2に無効
- RifampicinがNVP濃度を下げる
INIs
- Dolutegravir DTG
- Raltegravir RAL
- very well tolerated
- rapid viral suppression
- lesser drug interaction
- high threshold resistance
- Doltegravir DTG
- 1st line としてEFVに取って代わった
- once daily
- no food interaction
- neural tube defectがわずかに増加する；妊娠可能女性では十分な説明と同意
PIs
- 2nd line
- 下痢
- dyslipidemia, 耐糖能異常
- lipodystrophy syndrome
- CYP3A4阻害
- boosting PIs；PIをごく少量の他のPI ritonavirと併用
- -rを付す
- Lopinavir-Ritonavir LPV-r
- Atazanavir ATV-r
- 高ビリルビン血症，黄疸
WHO 1st line
- TDF+3TC+DTG
- TDF+3TC+EFV
WHO 2nd line
- NRTI+NRTI+INI
- NRTI+NRTI+PI
CPT
Co-trimoxazole preventive therapy
- 480-960mg/日 ST合剤
Treatment of advanced HIV
Minimum package of diagnostics for advanced HIV
IRIS
Immune reconstitution inflammatory syndrome
- importance to monitor IRIS
- CD4 count が低い状態で日和見感染を開始するときはARTは最低限1ヶ月空けてから
- paradoxical IRIS
フォローアップ
- 治療効果判定にはviral load
- CD4 countは初診時には有用だがフォローアップには無用；viral loadが大事
