ART治疗指南解读__培训课件.pptVIP

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ART治疗指南解读__培训课件.ppt

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希望与挑战 ART已经带来了治疗上的巨大进步 HIV成为能长期存活的慢性病，但需终生治疗能达到清除概念的新策略是我们接下来的挑战仍应关注HIV及其治疗相关的发病率 * 目前面临的热点问题多种非AIDS事件在HIV治疗后发生率增加心血管疾病[1-4] 癌症(非AIDS) 骨折/骨质疏松[5,6] 左室功能障碍肝脏衰竭[7] 肾脏衰竭认知减退(有争议)[8] 衰弱[9] 1. Klein D, et al. J Acquir Immune Defic Syndr. 2002;30:471-477. 2. Hsue P, et al. Circulation. 2004;109:316-319. 3. Mary-Kraus M, et al. AIDS. 2003;17:2479-2486. 4. Grinspoon SK, et al. Circulation. 2008;118:198-210. 5. Triant V, et al. J Clin Endocrinol Metab. 2008;93:3499-3504. 6. Arnsten JH, et al. AIDS. 2007 ;21:617-623. 7. Odden MC, et al. Arch Intern Med. 2007;167:2213-2219. 8. McCutchan JA, et a. AIDS. 2007 ;21:1109-1117. 9. Desquilbet L, et al. J Gerontol A Biol Sci Med Sci. 2007;62:1279-1286 * 谢　谢 * * DHHS, US Department of Health and Human Services; HBV, hepatitis B virus; HIVAN, HIV-associated nephropathy. ? This slide lists the DHHS guidelines released on World AIDS Day, December 1, 2009. The guidelines state that HAART should be initiated at CD4+ cell counts between 350?and 500?cells/mm^3. The asterisk indicates that 55% of panel members strongly recommended initiation at these CD4+ cell counts and 45% moderately recommended it. Essentially, all members of the panel at least moderately recommended initiating therapy when the CD4+ count is ≤ 500 cells/mm^3. The final category is CD4+ cell counts 500 cells/mm^3, and on this issue, the panel was equally divided. One half of the members favored initiating therapy regardless of CD4+ cell count—that is, even in those patients with CD4+ cell counts 500 cells/mm^3—whereas the remaining one half thought that the recommendations should view this number as an optional threshold for initiation of therapy. ? There are some conditions listed that favor initiation of antiretroviral therapy regardless of the CD4+ cell count, including history of an AIDS-defining illness, certain opportunistic infections, pregnancy, HIV-associated nephropathy, hepatitis B coinfection when hepatitis B treatment is indicated, rapid CD4+