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„State of the HAART“

Aktuelle Strategien zur antiretroviralen Therapie

“State of the HAART” — Current strategies for antiretroviral therapy

  • Arzneimitteltherapie
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Zusammenfassung

Das Ziel der antiretroviralen Therapie ist es, die Krankheitsprogression zu stoppen und die Lebenserwartung HIV-infizierter Menschen an die nicht-infizierter anzugleichen. Voraussetzung ist die Verhinderung einer Resistenzentstehung im Behandlungsverlauf. Entscheidend sind die Compliance des Patienten, die genügende enterale Resorption und die Kontrolle von Interaktionen sowie die Verträglichkeit und die volle antivirale Aktivität der eingesetzten Substanzen gegen das Virus. Ungenügende Medikamentenexposition bei Protease-Inhibitoren wird durch Einsatz eines Boosters überwunden.

Die Resistenzentstehung bei HIV lässt sich in einem Phasenmodell beschreiben:

1. Phase::

Replikation von Wildtyp unter nicht supprimierender Therapie.

2. Phase::

Transformation in ein resistentes Virus. Ziel: der Erhalt zukünftiger Behandlungsoptionen durch resistenzgesteuerte, präventive Therapieumstellung.

3. Phase::

Replikation von resistentem Virus (keine weiteren Mutationen mehr möglich).

a):

stabile Immunlage: Belassen der versagenden Therapie.

b):

drohende Krankheitsprogression: resistenzgesteuerter Wechsel auf ein Salvage-Regime.

Abstract

The goal of antiretroviral therapy is to interrupt the disease progression and to approach normal life expectancy for individuals with HIV. The condition for this is to deter the emergence of resistant HIV. This aim is achieved by improved patient drug adherence, sufficient enteral resorption and the control of interactions, as well as good tolerability and full antiviral activity. An insufficient drug exposure for protease inhibitors is overcome by the use of a booster agent.

Emerging HIV-resistance can be described in a phase model:

Phase 1::

replication of wild-type HIV under incomplete suppressive therapy.

Phase 2::

transformation of wild-type into resistant HIV through accumulation of mutations. A preventive, resistance-guided switch of therapy preserves therapeutic options for the future.

Phase 3::

replication of resistant HIV (no more mutations possible).

a):

stable immunity: continue with failing therapy.

b):

threatening disease progression: resistance-guided switch to a salvage-regimen.

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Abbreviations

HAART:

„highly active antiretroviral therapy“

NUK =NRTI:

Nukleosidale Reverse-Transkriptase-Inhibitoren

NNRTI:

Nichtnukleosidale Reverse-Transkriptase-Inhibitoren

PI:

Protease-Inhibitoren

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Authors and Affiliations

  1. Schwerpunkt HIV am Zentrum der Inneren Medizin, Klinik II, Klinikum der Johann-Wolfgang-Goethe-Unversität Frankfurt

    S. Staszewski &  C. Stephan

  2. Zentrum der Inneren Medizin, Klinik II HIV-Schwerpunkt, Klinikum der Johann-Wolfgang-Goethe-Unversität, Theodor-Stern-Kai 7, 60590, Frankfurt

    C. Stephan

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  1. S. Staszewski
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  2. C. Stephan
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Correspondence to C. Stephan.

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Staszewski, S., Stephan, C. „State of the HAART“. Internist 45, 1428–1436 (2004). https://doi.org/10.1007/s00108-004-1311-7

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