Adherence to Antiretroviral Therapy Merging the Clinical and Social Course of AIDS 英文参考文献.docVIP
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Adherence to Antiretroviral Therapy Merging the Clinical and Social Course of AIDS 英文参考文献
Open access, freely available online
Essay
Adherence to Antiretroviral Therapy: Merging
the Clinical and Social Course of AIDS
Arachu Castro
T
he survival of people diagnosed
with HIV/AIDS dramatically
improves with access to
and fusion inhibitors—to suppress
viral replication, and, thus, reduces
the likelihood of developing HIV
mutations that could lead to the
development of drug-resistant viral
strains. HAART also prevents further
viral destruction of the cellular
immune system, thereby, allowing for
increases in the level of CD4+ cells,
which improves the immunologic
response to opportunistic infections.
However,
suboptimal
treatment
adherence has
been associated
with virologic,
immunologic, and
clinical failure. In
this essay, I look
prescribed doses on time [1]. For many
people, this means taking a regimen of
three antiretrovirals twice per day—on
both occasions, they are usually taking
several pills [2]. An increasing number
of studies show that the relationship
between adherence and resistance
is drug speci?c [3]. Although the
suggestion that this relationship follows
a bell-shaped curve has existed since just
after the introduction of HAART [4],
there is increasing evidence that drug
resistance is highest among those taking
70%–80% of regimens containing a
nonboosted PI (i.e., regimens with
no combined ritonavir), and among
those with intermittent or single-dose
regimens of non-nucleoside reverse
transcriptase inhibitors (including when
nevirapine is used once to prevent
mother-to-child transmission of HIV)
or with poor adherence to these types
of antiretrovirals. Ritonavir-boosted
PIs (a full dose of a PI combined with
ritonavir to increase the blood levels of
the former) confer limited resistance,
regardless of one’s level of adherence
[3].
highly active antiretroviral therapy
(HAART). Such therapy employs
a combination of antiretroviral
agents—protease inhibitors (PIs),
nucleoside reverse transcriptase
inhibitors, non-nucleoside r
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