Please wait a minute...
浙江大学学报（医学版）
浙江大学学报（医学版）  2015, Vol. 44 Issue (6): 597-602    DOI: 10.3785/j.issn.1008-9292.2015.11.01
指南与实践     
《艾滋病诊疗指南第三版(2015版)》更新解读
孙建军1, 卢洪洲1,2
1. 复旦大学附属上海市公共卫生临床中心感染一科, 上海 201508;
2. 复旦大学附属华山医院感染病科, 上海 200040
Highlights of the third edition of Chinese guidelines for AIDS diagnosis and treatment(2015)
SUN Jian-jun1, LU Hong-zhou1,2
1. Department of Infectious Diseases, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China;
2. Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China
全文: PDF(900 KB)  
摘要: 

2015年中华医学会感染病学分会艾滋病学组发布了第三版《艾滋病诊疗指南》。新版指南强调抗病毒治疗时点前移:一旦成人确诊感染人类免疫缺陷病毒(HIV),若无禁忌宜尽早启动抗HIV治疗。对于合并机会性感染的HIV感染者,在感染控制、病情稳定后也应及早开始抗病毒治疗。尤其强调HIV合并结核患者在CD4阳性淋巴细胞数少于200/μL的情况下,建议抗结核两周内即开始抗病毒治疗。在抗HIV治疗用药中,淘汰了一些毒副作用大、依从性较差的药物,如司他夫定、去羟肌苷、茚地那韦等,优选抗病毒效力强、服药方便的组合,如拉米夫定、替诺福韦、依非韦伦组合。对于HIV感染的婴幼儿,亦主张及早抗HIV治疗。对于五岁以内的幼儿,主张确诊后即启动抗病毒治疗。对于HIV感染的孕产妇,建议尽快予以全程、联合抗HIV治疗,寓防于治。
关键词 ： 获得性免疫缺陷综合征/诊断,  获得性免疫缺陷综合征/药物疗法,  抗病毒药/治疗应用,  药物疗法,联合    
Abstract：

The third edition of Chinese guidelines for AIDS diagnosis and treatment was launched in 2015 by AIDS Professional Group, Society of Infectious Diseases, Chinese Medical Association. New edition emphasizes the importance of timely initiation of anti-retroviral therapy(ART). Like other guidelines, this edition recommends that once the HIV infection is confirmed, the ART should be initiated timely. For patients with HIV and opportunistic infections, once the infections are under control, the ART should be initiated without delay. For AIDS patients complicated with tuberculosis whose CD4 cell counts are less than 200/μL, the ART should start within 2 weeks after the initiation of anti-tuberculosis treatment. In this guideline, the drugs with severe toxicities and poor tolerance are excluded, and new drugs are added such as rilpivrine (RPV) and atazanavir (ATV) because of less toxicity and higher HIV depression effect; and 3TC+TDF+EFV is recommended as the first line regimen. As for children with HIV infection, especially for those less than 5 years, once the infection is confirmed the ART should be initiated immediately. For the prevention of HIV mother to children transmission, new edition recommends that HIV-infected pregnant women start ART early and keep on ART all their lives.
Key words： Acquired immunodeficiency syndrome/diagnosis    Acquired immunodeficiency syndrome/drug therapy    Antiviral agents/therapeutic use    Drug therapy, combination
收稿日期: 2015-10-10
CLC:  R512.91  
基金资助:

"十二五"国家传染病防治科技重大专项(2012ZX10001-003)
通讯作者: 卢洪洲(1966-),男,博士,教授,主任医师,博士生导师,主要从事艾滋病的基础与临床研究;E-mail:luhongzhou@fudan.edu.cn;http://orcid.org/0000-0002-8308-5534     E-mail: luhongzhou@fudan.edu.cn
作者简介: 孙建军(1983-),男,博士研究生,主要从事艾滋病的发病机制研究;E-mail:sunjianjun06@aliyun.com;http://orcid.org/0000-0001-5780-5334
服务　　
把本文推荐给朋友
加入引用管理器
E-mail Alert
RSS
作者相关文章　　

引用本文:

孙建军等. 《艾滋病诊疗指南第三版(2015版)》更新解读[J]. 浙江大学学报（医学版）, 2015, 44(6): 597-602.
SUN Jian-jun, LU Hong-zhou. Highlights of the third edition of Chinese guidelines for AIDS diagnosis and treatment(2015). Journal of ZheJiang University(Medical Science), 2015, 44(6): 597-602.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2015.11.01      或      http://www.zjujournals.com/xueshu/med/CN/Y2015/V44/I6/597

[1] WHO STATEMENT. Accelerate expansion of antiretroviral therapy to all people living with HIV: WHO[DB/OL]. (2015-11-30)[2015-12-10].http://www.who.int/mediacentre/news/statements/2015/antiretroviral-therapy-hiv/en/.
[2] 中华医学会感染病分会艾滋病学组.艾滋病诊疗指南[J]. 中华传染病杂志, 2011, 29(10):629-640. AIDS Professional Group, Society of Infectious Diseases, Chinese Medical Association. Chinese guidelines for AIDS diagnosis and treatment[J]. Chinese Journal of Infectious Diseases, 2011, 29(10):629-640.(in Chinese)
[3] 中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南第三版(2015版)[J]. 中华临床感染病杂志, 2015, 8(5):385-401. AIDS Professional Group, Society of Infectious Diseases, Chinese Medical Association. The third edition of Chinese guidelines for AIDS diagnosis and treatment(2015)[J]. Chinese Journal of Clinical Infectious Diseases, 2015, 8(5):385-401.(in Chinese)
[4] FAUCI A S, MARSTON H D. Ending the HIV-AIDS pandemic-follow the science[J]. N Engl J Med, 2015, 373(23):2197-2199.
[5] FRIEDEN T R, FOTI K E, MERMIN J. Applying public health principles to the HIV epidemic-how are we doing?[J]. N Engl J Med, 2015, 373(23):2281-2287.
[6] Insight Start Study Group, LUNDGREN J D, BABIKER A G, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection[J]. N Engl J Med, 2015, 373(9):795-807.
[7] COHEN C, WOHL D, ARRIBAS JR, et al. Week 48 results from a randomized clinical trial of rilpivirine/emtricitabine/tenofovir disoproxil fumarate vs. efavirenz/emtricitabine/tenofovir disoproxil fumarate in treatment-naive HIV-1-infected adults[J]. AIDS, 2014, 28(7):989-997.
[8] COHEN C J, MOLINA J M, CASSETTI I, et al. Week 96 efficacy and safety of rilpivirine in treatment-naive, HIV-1 patients in two Phase III randomized trials[J]. AIDS, 2013, 27(6):939-950.
[9] SARFO F S, SARFO M A, NORMAN B, et al. Incidence and determinants of nevirapine and efavirenz-related skin rashes in West Africans: nevirapine's epitaph?[J]. PLoS ONE, 2014, 9(4):e94854.
[10] LENNOX J L, LANDOVITZ R J, RIBAUDO H J, et al. Efficacy and tolerability of 3 nonnucleoside reverse transcriptase inhibitor-sparing antiretroviral regimens for treatment-naive volunteers infected with HIV-1: a randomized, controlled equivalence trial[J]. Ann Intern Med, 2014, 161(7):461-471.
[11] MOLLAN K R, SMURZYNSKI M, ERON J J, et al. Association between efavirenz as initial therapy for HIV-1 infection and increased risk for suicidal ideation or attempted or completed suicide: an analysis of trial data[J]. Ann Intern Med, 2014, 161(1):1-10.
[12] CIARANELLO A L, DOHERTY K, PENAZZATO M, et al. Cost-effectiveness of first-line antiretroviral therapy for HIV-infected African children less than 3 years of age[J]. AIDS, 2015, 29(10):1247-1259.
[13] PENAZZATO M, PRENDERGAST A J, MUHE L M, et al. Optimisation of antiretroviral therapy in HIV-infected children under 3 years of age[J]. Cochrane Database Syst Rev, 2014, 5:CD004772.
[14] PALUMBO P, LINDSEY J C, HUGHES M D, et al. Antiretroviral treatment for children with peripartum nevirapine exposure[J]. N Engl J Med, 2010, 363(16):1510-1520.
[15] PESSÔA M G, GAZZARD B, HUANG A K, et al. Efficacy and safety of entecavir for chronic HBV in HIV/HBV coinfected patients receiving lamivudine as part of antiretroviral therapy[J]. AIDS, 2008, 22(14):1779-1787.
[16] European Association for Study of the Liver. EASL recommendations on treatment of hepatitis C 2015[J]. J Hepatol, 2015, 63(1):199-236.
[17] CHENG W, WU Y, WEN Y, et al. Cotrimoxazole prophylaxis and antiretroviral therapy: an observational cohort study in China[J]. Bull World Health Organ, 2015, 93(3):152-160.
[18] 马 倩, 张志勇, 卢洪洲, 等. MRI对神经系统免疫重建炎性综合征的诊断价值[J]. 放射学实践, 2014, 29(04):457-459. MA Qian, ZHANG Zhi-yong, LU Hong-zhou, et al. The diagnostic value of MRI for the determination of nervous system IRIS[J]. Radiol Practice, 2014, 29(04):457-459.(in Chinese)
[19] BLANC F X, SOK T, LAUREILLARD D, et al. Earlier versus later start of antiretroviral therapy in HIV-infected adults with tuberculosis[J]. N Engl J Med, 2011, 365(16):1471-1481.
[20] TOROK M E, YEN N T, CHAU T T, et al. Timing of initiation of antiretroviral therapy in human immunodeficiency virus (HIV)-associated tuberculous meningitis[J]. Clin Infect Dis, 2011, 52(11):1374-1383.
[21] 中华医学会结核病学分会.非结核分枝杆菌病诊断与治疗专家共识[J]. 中华结核和呼吸杂志, 2012, 35(8):572-580. Chinese Society of Tuberculosis, Chinese Medical Association. The consensus of diagnosis and treatment for nontuberculous mycobacterial in China[J]. Chinese Journal of Tuberculosis Respiratory Diseases, 2012, 35(8):572-580. (in Chinese)
[22] 韦善求, 罗晓璐, 苏国生, 等. 艾滋病合并马尔尼菲青霉病的血液细胞学特点[J]. 广西医学, 2015, 37(4):541-542. WEI Shan-qiu, LUO Xiao-lu, SU Guo-sheng, et al. The characteristics of blood cell of patients with AIDS and penicilliposis marneffei[J]. Guangxi Medical Journal, 2015, 37(4):541-542. (in Chinese)
[23] FUNDARO C, GENOVESE O, RENDELI C, et al. Myelomeningocele in a child with intrauterine exposure to efavirenz[J]. AIDS, 2002, 16(2):299-300.
[1] 王炬峰 等. 高效抗逆转录病毒治疗对人类免疫缺陷病毒感染者骨代谢的影响[J]. 浙江大学学报（医学版）, 2016, 45(3): 228-235.
[2] 沈银忠 等. 人类免疫缺陷病毒暴露前预防的应用与挑战[J]. 浙江大学学报（医学版）, 2016, 45(3): 221-227.
[3] 吴丽娟，靳昌忠，白石，梁勇，吴南屏. 合并病毒性肝炎HIV感染患儿接受高效抗逆转录酶病毒治疗后肝功能变化[J]. 浙江大学学报（医学版）, 2014, 43(2): 180-186.
[4] 孙健,吴南屏,冯婷婷,冯磊,Norbert Brockmeyer. 长期高效抗逆转录病毒治疗对HIV-1感染者体内异常免疫激活和免疫重建的影响[J]. 浙江大学学报（医学版）, 2010, 39(6): 618-622.
[5] 姚航平，靳昌忠，张福杰，冯磊，魏红山，吴灵娇，郜桂菊，Armin Bader，Norbert Brockmeyer，吴南屏. 高效抗逆转录病毒治疗对AIDS患者MCP-1和MSP水平的影响[J]. 浙江大学学报（医学版）, 2007, 36(2): 174-178.
[6] 陈祥明;柳子明;杜心芳;羊正纲;陈晓明. 拉米夫定联合胸腺肽α1治疗鸭乙型肝炎的效果观察[J]. 浙江大学学报（医学版）, 2005, 34(2): 121-125.