HIV耐药检测在临床中的应用2-北京佑安医院.pptVIP

* * 3TC, lamivudine; FTC, emtricitabine; ITT, intent to treat; NS, not significant; Rx, treatment; TI, treatment interruption; VL, viral load. Several studies have demonstrated that lamivudine continues to show antiviral activity, even after development of the M184V mutation. In this study, 58 patients were randomized to either continue lamivudine as monotherapy or undergo a complete treatment interruption after they developed the M184V mutation. In the figure on the left, patients who had ongoing treatment with lamivudine had a smaller increase in their HIV RNA level. Consistent with this result, on the right side of the figure, these patients had a slower decline in their CD4+ cell count. In addition, replication capacity was assayed; patients who continued taking lamivudine had a lower replication capacity vs those who stopped their treatment entirely. Importantly, continuing lamivudine did not select for further NRTI resistance mutations. * 3TC, lamivudine; ABC, abacavir; ddI, didanosine; FTC, emtricitabine; TDF, tenofovir; ZDV, zidovudine. Which NRTI combinations should be used after the development of M184V? No prospective data indicate the optimal NRTI choice, but based on the results of lamivudine discontinuation studies and resistance testing, the following 4 choices are likely to be the most active: zidovudine/lamivudine, tenofovir + zidovudine, tenofovir/emtricitabine, and tenofovir/emtricitabine + zidovudine. If the above combinations cannot be used, then these combinations would also retain activity: didanosine + lamivudine, abacavir/lamivudine, and zidovudine/lamivudine/abacavir. In general, tenofovir + didanosine should be avoided, even though both components retain activity against M184V?containing viruses, for reasons discussed on the next slide. * 3TC, lamivudine; ddI, didanosine; EFV, efavirenz; NVP, nevirapine; TDF, tenofovir. This slide summarizes why the combination of didanosine and tenofovir should be avoided. There is a drug-drug interacti