[The concept of therapeutic management: exemplary implementation of antiretroviral treatments].
Since the discover of AIDS in 1981 and the causal human immunodeficiency virus in 1983, therapeutic strategies have gone through many phases. When the ACTG 175 and Delta trials demonstrated the clinical improvement offered by regiments combining 2 nucleosides over monotherapy, combination therapy was being prescribed for less than 20% of all primary infections. Less than one year later, this rate suddenly rose to 90%. At the same time, the clinical benefit in terms of reduced morbidity and mortality was demonstrated for triple therapy and by the end of 1997, 65% of all treated HIV+ patients were taking the triple combination therapy, 34% were on bitherapy and only 1% on single drug regimens. This fantastically rapid evolution of management strategies appears even more exceptional when one realizes that these changes in prescription attitudes took place before expert groups were able to establish accepted guidelines. The number of patients under treatment also rose sharply from 57% in early 1994 to 87% in late 1997, while the number of active hospital files rose by 30%. These rapid changes in patient management schemes has had a major effect on HIV-related morbidity and mortality. In 1997, the number of deaths fell by 41% and the number of new AIDS cases by nearly 50%. The number of hospitalizations has also declined by 50% over the last 2 years. This is probably the first time in the history in medicine that preliminary clinical studies have led to direct patient benefit in so short a time. This achievement has been accomplished by the combined efforts of health care workers, patient associations, public authorities and the pharmaceutical industry. This global view must not however hide the fact that most all the prescriptions used today are based on the results of clinical trials in a small number of patients over short study periods. Long-term efficacy and tolerance remain unknown. One must also keep in mind one other figure which has not varied over this period. The percentage of new AIDS cases in patients no ith no prior treatment because they are unaware of the infection or because they do not want treatment remains unchanged at 40%.
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Rozenbaum
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D019468:Disease Management; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D013997:Time Factors
D019380:Anti-HIV Agents
Du concept à la prise en charge thérapeutique: la mise en oeuvre exemplaire des traitements antirétroviraux.