Medizinische Klinik

, Volume 92, Issue 6, pp 344–346 | Cite as

Viral Load — Bedeutung für die individualisierte Therapie

  • Hans Jäger
Übersicht
  • 17 Downloads

Zusammenfassung

Die Behandlung der HIV-Erkrankung hat sich durch ein neues pathophysiologisches Verständnis grundlegend gewandelt. Der leitende Laborparameter für die Therapieentscheidungen ist heute die Bestimmung der im Plasma gemessenen Viruslast.

Elf Medikamente stehen in Deutschland zur Reduktion der HIV-Menge im Blut zur Verfügung. Etwa zwei Drittel der Behandler beginnen mit einer Zweifachkombination. Protease-Inhibitoren stellen eine wichtige Erweiterung der Therapieoptionen dar.

Viral load — Its importance for an individual treatment

Summary

The treatment of HIV infection/AIDS has changed dramatically because of a new pathophysiological understanding of this disease. The most important laboratory parameter for the management of antiretroviral therapy is the direct measurement of virus load in plasma.

In Germany 11 different medications are available to the patient for reduction of his viral load in blood and possibly tissue, i.e. lymph-nodes. The majority (about 2/3) of physicians begin to treat with double combination therapy. Protease inhibitors are an important addition to the therapeutic arsenal.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. 1.
    Bush, C. E., R. M. Donovan, N. Markowitz, D. Baxa, P. Kvale, L. D. Saravolatz: Gender is not a factor in serum human immunodeficiency virus type 1 RNA levels in patients with viremia. J. clin. Microbiol. 34 (1996), 970–972.PubMedGoogle Scholar
  2. 2.
    Cao, Y., L. Qin, L. Zhang, J. Safrit, D. D. Ho: Virologic and immunologic characterization of long-term survivors of human immunodeficiency virus type 1 infection. New Engl. J. Med. 201 (1995), 202–208.Google Scholar
  3. 3.
    Cheeseman.Google Scholar
  4. 4.
    Delta-Studie: Durchbruch für Kombinationstherapie bei HIV-Infektion. Info IV/95 des RKI 1995.Google Scholar
  5. 5.
    Dewar, R. L., H. C. Highbarger, M. D. Sarmiento, J. A. Todd, M. B. Vasudevachari, T. Davey, A. Kovacs, N. P. Salzman, C. H. Lane, M. S. Urdea: Application of branched DNA signal amplification to monitor human immunodeficiency virus type 1 burden in human plasma. J. infect. Dis. 170 (1994), 172–179.Google Scholar
  6. 6.
    Dickover, R. E., E. M. Garratty, St. A. Herman, M. S. Sim, S. Plaeger, P. J. Bover, M. Keller, A. Deveikis, E. R. Stiehm, Y. J. Bryson: Identification of levels of maternal HIV-1 RNA associated with risk of perinatal transmission. J. Amer. med. Ass. 275 (1996), 599–605.CrossRefGoogle Scholar
  7. 7.
    Emini, E. A.: Protease inhibitors. 3rd Conference on Retroviruses and Opportunistic Infections. Washington D.C. January 28th. 1996.Google Scholar
  8. 8.
    Eron, J. J., S. L. Benoit, J. Jemsek: Treatment with Lamivudine, Zidovudine or both in HIV-positive patients with 200 to 500 CD4+ cells per cubic millimeter. New Engl. J. Med. 21 (1995).Google Scholar
  9. 9.
    Fang, G., H. Burger, P. Tropper, S. Nachman, H. Viscosi, R. Moore, R. Grimson, G. Baxter, N. Sporysz, C. Reyelt, N. Hutcheon, B. Weiser: QC-PCR quantitation of HIV 1 plasma RNA level during pregnancy: relationship to mother-to-child transmission and antiviral therapy. 2nd National Conference Human Retroviruses and Related Infections. Washington D. C. 1995, Abstract No. 441.Google Scholar
  10. 10.
    Havlier, D., M. M. McLaughlin, D. D. Richman: A pilot study to evaluate the development of resistance to nevirapine in asymptomatic human immunodeficiency virus infected patients with CD4 cell count of >500/mm E3; AIDS clinical trials group control 20 B. J. infect. Dis. 172 (1995), 1379–1383.Google Scholar
  11. 11.
    Ho, D. D., A. U. Neuman, A. S. Perelson, W. Chen, J. M. Leonard, M. Markowitz: Rapid turnover of plasma virions and CD4 lymphocytes in HIV-1 infection. Nature (Lond.) 373 (1995), 123–126.CrossRefGoogle Scholar
  12. 12.
    Katlama, C., J. M. Molina, W. Rozenbaum: Stavudine (D4T) in HIV-infected patients with CD4>350/mm3: results of a double-blind randomised placebo controlled study. 3rd Conference on Retroviruses and Opportunistic Infections, Washington D. C. 1996.Google Scholar
  13. 13.
    Jäger, H., R. Wagner: Zuverlässig und schnell per Virusquantifizierung. Sonderdruck. Dtsch. Ärztebl. 50/A (1995), 3545–3548.Google Scholar
  14. 14.
    Mellors, J. W., L. A. Kingsley, C. R. Rinaldo, J. A. Todd, B. S. Hoo, R. P. Kokka, P. Gupta: Quantitation of HIV-1 RNA in plasma predicts outcome of HIV-1 after seroconversion. Ann. intern. Med. 122 (1995), 573–579.PubMedGoogle Scholar
  15. 15.
    Molla, A.: The potential of ritonavir in combination therapy. Workshop: HIV protease inhibitors. San Francisco June 11th, 1996.Google Scholar
  16. 16.
    Para, M. F., M. Fisch, P. Meehan, W. Freimuth, G. Morse, L. Demeter, K. Wood, R. Shafer, J. Holden-Wiltse: ACTG-260: Randomized phase I/II dose-ranging trial of the anti-activity of delavirdine. Abstract 1996.Google Scholar
  17. 17.
    Piatak, M., M. S. Saag, L. C. Yang, S. J. Clark, J. C. Kappes, K. C. Luk, B. H. Hahn, G. M. Shaw, J. D. Lifson: High levels of HIV-1 plasma RNA during all stages of infection determined by competitive PCR. Science 259 (1993), 1749–1754.PubMedCrossRefGoogle Scholar
  18. 18.
    Pollard, R., D. Peterson, D. Hardy: Antiviral effect and safety of stavudine (d4T) and didanosine (ddI) combination therapy in HIV-infected subjects in an ongoing pilot randomized double blinded trial. 3rd Conference on Retroviruses and Opportunistic Infections, Washington D. c. 1996.Google Scholar
  19. 19.
    Ruffault, A., C. Michelet, C. Jacquelinet, O. Guist’hau, N. Genetet, C. Bariou, R. Colimon, F. Cartier: The prognostic value of plasma viremia in HIV-infected patients under AZT treatment: a two-year-follow-up-study. J. Aids human Retrovir. 9 (1995), 243–248.Google Scholar
  20. 20.
    Shepp, D. H., A. Ashra: Effect of didanosine on human immunodeficiency virus viremia and antigenemia in patients with advanced disease: correlation with clinical response. J. infect. Dis. 167 (1993), 30–35.PubMedGoogle Scholar
  21. 21.
    Tiller, F. W., E. Wolf, F. Gräbnitz, E. Jägel-Guedes, H. Jäger: Application of Q-NASBA for determining HIV-1 viral load in human plasma. Clin. Lab. 41 (1995), 769–772.Google Scholar
  22. 22.
    Volberding, P. A.: HIV quantification — clinical applications. Lancet 347 (1996), 71–73.PubMedCrossRefGoogle Scholar
  23. 23.
    Wie, X., S. K. Gosh, M. E. Taylor, V. A. Johnson, E. A. Emini, P. Deutsch, J. D. Lifson, S. Bonhoefer, M. A. Novak, B. H. Hahn, M. S. Saag, G. M. Shaw: Viral dynamics in human immunodeficiency virus type 1 infection. Nature (Lond.) 373 (1995), 117–122.CrossRefGoogle Scholar

Copyright information

© Urban & Vogel 1997

Authors and Affiliations

  • Hans Jäger
    • 1
  1. 1.KIS-Kuratorium für ImmunschwächeMünchen

Personalised recommendations