[Antiretroviral therapies].
SPARING ANTIPROTEASES: An antiprotease-sparing strategy can improve compliance and adhesion to antiretroviral treatments. Several studies have demonstrated that switching to neviparin or efavirenz can maintain viral suppression and allow satisfactory rise in CD4 counts with a significant reduction in the neviparin group. A switch to a tritherapy with nucleosides (abacavir) can increase the risk of virological failure but allows an improvement in lipid anomalies, simplified treatment, and better patient adhesion. LIPODYSTROPHY SYNDROMES: These syndromes develop in 30 to 50% of the cases depending on the study and appear to be linked to the duration of exposure to antiretroviral agents. Along with the associated metabolic anomalies, lipodystrophy plays a role in the cardiovascular risk related to these treatments. NEW ANTIRETROVIRAL DRUGS: Several clinical trials have been devoted to new antiretroviral drugs. DAPD was found to have a dose-dependent antiretroviral effect with good tolerance. A new antiprotease (BMS 232 632) offers the advantage of a single daily dose with good tolerance and good effectiveness compared with the reference treatment including nelfinavir. TDF (tenofovir disoproxyl fumarate) is a nucleotidic analogue of reverse transcriptase. Given in a single daily dose monotherapy regimen, it can provide prolonged retroviral suppression. Compared with nelfinavir, ABT 378 gave significantly higher viral loads < 400 copies/ml at 24 weeks with an identical clinical tolerance but with an advantage for cholesterol and triglyceride levels.
Dominguez
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Service des Maladies infectieuses et tropicales, Hôpital Pitié-Salpêtrière, 47-83, bd de l'Hôpital, F 75651 Paris.
Bricaire
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F
D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000480:Alkynes; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D048588:Benzoxazines; D003521:Cyclopropanes; D004148:Dioxolanes / Q000627:therapeutic use; D006801:Humans; D008060:Lipodystrophy / Q000139:chemically induced; D063065:Organophosphonates; D009943:Organophosphorus Compounds / Q000627:therapeutic use; D010078:Oxazines / Q000627:therapeutic use; D010349:Patient Compliance; D011480:Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011684:Purine Nucleosides / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000068698:Tenofovir; D019562:Viral Load
D000480:Alkynes; D000998:Antiviral Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D004148:Dioxolanes; D063065:Organophosphonates; D009943:Organophosphorus Compounds; D010078:Oxazines; D011480:Protease Inhibitors; D011684:Purine Nucleosides; D018894:Reverse Transcriptase Inhibitors; C098393:amdoxovir; D000068698:Tenofovir; D000225:Adenine; C098320:efavirenz