美国指南现在推荐使用多拉韦林治疗 HIV
美国卫生和人类服务部 (US Department of Health and Human Services) 公布的最新指南现在推荐，将基于多拉韦林的抗逆转录病毒治疗方案作为治疗某些患者人群 HIV 感染的初始选择。
根据该指南，基于多拉韦林的治疗目前是某些临床情况下（例如，不能耐受整合酶链转移反应抑制剂 [integrase strand transfer inhibitor, INSTI] 并希望使用不良反应风险较低的 NNRTI 的患者）的推荐初始治疗方案。但是，由于缺乏多拉韦林治疗与基于 INSTI 的治疗方案（目前的治疗选择）的比较数据，对于大多数人，尚不推荐将其作为初始治疗方案。
多拉韦林是一种新型非核苷类逆转录酶抑制剂 (NNRTI)，于 2018 年 8 月获得美国食品药品监督管理局批准，可与其他抗逆转录病毒药物联合用于治疗无既往抗逆转录病毒治疗史的 HIV-1 成年感染患者。该药物可为单一成分制剂，也可与拉米夫定和替诺福韦二吡呋酯制成复方制剂。该药物也被推荐在欧洲审批，正在等待最终裁定。
批准基于两项临床试验，试验结果显示多拉韦林/替诺福韦/拉米夫定不劣于基于依非韦伦和达芦那韦/利托那韦的治疗方案。与依非韦伦相比，多拉韦林通常具有更好的耐受性，具有更有利的血脂水平，更低的皮疹发生率和更少的中枢神经系统不良反应。最新的 DHHS 指南还纳入了有关有生育能力的女性和孕妇使用多替拉韦的推荐建议。
参见:治疗步骤 参见:治疗流程小结
定义
病史和查体
诊断性检查
治疗流程
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Assistant Professor of Medicine
Infectious Diseases
Northwestern Memorial Hospital
Chicago
IL
利益冲突披露
CJA has been a member of an advisory board on HIV, aging and telomeres for Viiv, and has done consultant work as a member of DSMBs for ABIVAX, Atea, and Biotron. He has also received a grant for Investigator Sponsored Research from Gilead.Dr Chad J Achenbach would like to gratefully acknowledge Dr Richard Rothman, Dr Michael Ehmann, Dr Linda-Gail Bekker, Dr Catherine Orrell, and Dr Lisa Capaldini, the previous contributors to this topic. ME, LGB, and CO declare that they have no competing interests. RR attended a symposium/conference hosted by a funding agency, Gilead HIV FOCUS program, from which he receives research funds. RR pays staff for an implementation/research program grant from Gilead HIV FOCUS for development of HIV testing programs in Emergency Departments. LC is on the speakers' bureau for the following pharmaceutical companies: GlaxoSmithKline, BMS, Merck, Gilead, Roche, Pfizer, Solvay, Lilly, Serrano, and Tibotec.
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Clinical Assistant Professor
University of British Columbia
Vancouver
Canada
利益冲突披露
MH is a member of an advisory board and/or speakers' bureau for Gilead Sciences Canada Inc, Merck Canada Inc, and ViiV Healthcare.Assistant Professor of Medicine
Harvard Medical School
Director of Research
Global Health Delivery Project
Harvard School of Public Health
Boston
MA
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WR declares that he has no competing interests.Infectious Disease Physician
Oxford University Clinical Research Unit
Hospital for Tropical Diseases
Ho Chi Minh City
Vietnam
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JD declares that he has no competing interests.
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