《艾滋病诊疗指南第三版(2015版)》更新解读  

Highlights of the third edition of Chinese guidelines for AIDS diagnosis and treatment(2015)

作　　者：孙建军[1] 卢洪洲[1,2] 

机构地区：[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

出　　处：《浙江大学学报（医学版）》2015年第6期597-602,共6页Journal of Zhejiang University(Medical Sciences)

基　　金：“十二五”国家传染病防治科技重大专项(2012ZX10001-003)

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。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 CIM cell counts are less than 200/p^L, 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.

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 

分 类 号：R512.91[医药卫生—内科学]