ARV副作用分析课件.ppt

ARV 副作用 HIV － 干预点 抗病毒药物组 核苷类逆转录酶抑制剂（NRTI） 非核苷类逆转录酶抑制剂（NNRTI） 蛋白酶抑制剂（PI） 融合抑制剂（T20） CCR5抑制剂 －（马拉韦罗） 整合酶抑制剂 － 雷特格韦 中国当前可用的抗病毒药物 皮疹分级 1级：轻度 红斑，伴或不伴搔痒 皮疹分级 2级：中度 弥漫性斑丘疹，或 干性脱屑，或 典型靶损伤，无大泡、小泡或溃疡，和 无全身症状（发热、肌肉痛、关节痛） 皮疹分级 3级：中度 起疱 湿性脱屑 溃疡 弥漫性皮疹和全身症状（发热、大泡、肌肉和/或关节痛、水肿、转氨酶升高） 皮疹分级 4级：可能危及生命 粘膜受累 可疑S-J 综合征 多形性红斑 脱落性皮炎 November 2001 3 S. Selelo 概述 of 抗病毒药物 The first three (NRTI, NNRTI, PI) are available and commonly used in Vietnam. The last 2 classes are newer, very expensive, and not yet available in Vietnam. This is the same slide with the drugs not available in vietnam removed. You can flick backward and forward for effect. Although many ARVs available overseas are not available in Vietnam, in fact the most important and essential drugs and the most commonly prescribed drugs world wide are available It is also useful to note, that often the drugs are written using a 3 letter abbreviation, which you see here before the drugs full name. This is just a convenient way of writing and referring to the drugs Grade 1 rash: This patient has redness without raised lesions, breaks in the skin, or systemic symptoms. May or may not be pruritic (itchy). Grade 2 rash: rash is diffuse and may be raised. No vesicles, blisters, or ulcers. No systemic symptoms. Grade 3 rash: there may be vesicles, desquamation, and/or systemic symptoms. Grade 4 rash: very severe and potentially fatal: may have extensive desquamation and mucous membrane involvement. 皮疹粘膜受累，危险指征 Blistering水泡 Mucosal involvement粘膜受累 NVP 肝炎常见: 15% 生化异常 ， 5% 症状 女性较常见 约50%肝炎是全身性过敏性皮疹的一部分 CD4计数高时更常见（女性250男性400） NVP肝炎的处理 无症状 ALT 5 × 正常值上限（ULN），监测 ALT 5 × ULN 停药考虑 EFV 有症状— 肝炎或皮疹 永远停用 EFV 暂时性的神经系统副作用很常见 失眠 生动的梦 头晕 烦躁不安/极度兴奋 致畸作用 NNRTIs –副作用通常出现的时间 0-3 months 3-6 months 6 months Rash Neuropsychiatric Rash Hepatitis Nevirapine Efavirenz 蛋白酶抑制剂 PIs class effect 呕吐腹泻 肝炎（特别是利托那韦） ? 甘油三酯 LDL胆固醇 变数（AZT最少见RTV最