九种抗HIV药物介绍

1、齐多夫定
　　
　　齐多夫定一直以来都是首选抗HIV药物，但今年初美国人把它降为次选药物。为什么呢?原因有二;1.齐多夫定有骨髓抑制的副作用，而血细胞是骨髓产生的，所以齐多夫定降低白细胞从而影响CD4细胞(它是白细胞的一种)上升。有的患者说：我的病毒检测不出了，为什么CD4细胞长得不好呢?原因是多方面的，其中之一就是你可能用的是齐多夫定。2.齐多夫定也可以造成脂肪萎缩，虽然比司他夫定轻一些，但是比替诺福韦和阿巴卡韦重多了。美国人因此把替诺福韦和阿巴卡韦作为了首选的核苷类药物。
　　
　　齐多夫定经常和拉米夫定一起用，这两种药还做成了一片合剂。这是因为当病毒对拉米夫定耐药后反而对齐多夫定更加敏感。
　　
　　2、司他夫定
　　
　　司他夫定，英文简称d4T，1994年6月在美国上市。有胶囊和粉末2种形式，粉末是用来配置溶液供儿童服用的。要注意胶囊有2种，每粒含量分别是15毫克和20毫克，千万不要搞混了。像服用去羟肌苷一样，成人也是按体重服用。体重大于60公斤的每次40毫克，体重小于60公斤的每次30毫克，都是每12小时1次。也有专家建议不管体重多少都按每次30毫克，每12小时一次服用，这样可以减少不良反应，而疗效不受影响。但是，这种观点没有得到公认。
　　
　　3、拉米夫定
　　
　　拉米夫定，英文简称3TC，商品名益平维，1995年11月被批准用于艾滋病的抗病毒治疗。
　　
　　在中国，它可是赫赫有名的一个药。葛兰素公司生产的贺普丁就是拉米夫定，不过贺普丁每片含拉米夫定100毫克，是用来治疗慢性乙肝的。
　　
　　在艾滋病领域，它也堪称明星药物。艾滋病人第一次抗病毒治疗方案里几乎都含有该药。当然，该药也可以用另外一个药恩曲他滨(简称FTC)代替。这两个药的结构、作用机理、疗效、耐药等均类似。
　　
　　4、去羟肌苷
　　
　　该药结构和齐多夫定、司他夫定、拉米夫定都不同，所以一般来说当病毒对这3种药物耐药时，可以用去羟肌苷代替。也是因为这个原因，我国目前把去羟肌苷用作二线药物，这是合理的。用作二线药物并不是说这个药物没有齐多夫定和司他夫定好，我倒觉着如果不是考虑到把它留作二线药物的话，它应该取代司他夫定作为一线药物的。在美国，它和齐多夫定都是一线治疗里的次选药物。
　　
　　5、奈韦拉平
　　
　　奈韦拉平：英文简称NVP。有片剂和口乳液2种形式。它的服用方法比较特殊，有一个“导入期”。就是说，服药开始后的它头2周是导入期，每天服药1次，剂量200毫克。如果2周内没有明显不良反应，2周后再改为每天服药2次，每次200毫克。成年人服药方法为头2周每天1次，每次200毫克，2周后改为每天12小时1次，每次200毫克。儿童服用方法为头2周每天1次，每次120毫克/m3体表面积(最大不超过每次200毫克)，2周后改为12小时1次，每次120～200毫克/m2体表面积(最大不超过每次200毫克)。肝脏损害多发生于治疗后的头4个月内，其后也可发生，但一般不严重。
　　
　　如果服用奈韦拉平以后出现皮疹，一定要和医生联系或者去看病，特别是皮疹同时伴有发热时，更需警惕。严重皮疹(例如有水疱、溃疡、脱皮、粘膜损害等)必须停药。
　　
　　它的主要不良反应是皮疹和肝损害。CD4细胞计数高的患者(男性>400个/mm3，女性>250个/mm3)发生肝损害的危险性更高。所以，对于以前没有接受过抗病毒治疗的患者，如果CD4细胞计数高于以上两个界限值，要避免应用奈韦拉平。
　　
　　6、依非韦仑
　　
　　依非韦仑：英文简称EFV，商品名施多宁，属于非核苷类逆转录酶抑制剂，1998年9月份在美国上市。有胶囊和片剂2种形式。成年人每晚睡前服用1次，每次600毫克。儿童患者根据体重不同而服用不同剂量，具体如下：10~15公斤儿童每次200毫克，15~20公斤每次250毫克，20~25儿童每次300毫克，25~32.5公斤儿童每次350毫克，32.5~40公斤儿童每次400毫克，>40公斤儿童每次600剂量。都是每日1次，睡前服用。3岁以下或体重小于10公斤的儿童不要服用依非韦仑，这倒不是因为不能服用。只是因为目前依非韦仑还没有口服液，3岁以下的孩子不太会吞服胶囊或片剂，而体重小于10公斤的儿童服用依非韦仑的剂量还没有研究过，所以也无法服用。
　　
　　7、茚地那韦
　　
　　茚地那韦：英文简称IDV，进口的药品商品名佳息患，蛋白酶抑制剂，1996年3月在美国上市，为胶囊。成人服药方法为每次800毫克，每8小时1次。国外没有推荐儿童服用茚地那韦的方法，我国的《艾滋病诊疗指南》推荐儿童每次500毫克/m2体表面积(最大不超过每次800毫克)，每8小时1次。该药需要空腹服用。另外，为了避免发生肾结石，服用茚地那韦要大量饮水，成人每天饮水量至少要达到1.5升。血友病患者需要注意，茚地那韦可以增加出血的危险，因此要避免应用或者在严密监测下应用。其它不良反应主要是引起代谢异常，如高血脂、高胆固醇、血糖高、糖尿病、脂肪堆积等等。
　　
　　8、克力芝
　　
　　克力芝：它是利托那韦和洛匹那韦这两种蛋白酶抑制剂合在一起制成的，在中国主要是胶囊和口服液的形式，国外还有片剂。胶囊于2000年9月、片剂于2005年10月在美国上市。每粒胶囊含洛匹那韦133.3毫克和利托那韦33.3毫克，每毫升口服液含洛匹那韦80毫克和利托那韦20毫克。成人患者服用方法为每次3粒胶囊，每12小时1次。片剂由于每片含量大，只需每次2片，每12小时其次即可。儿童患者根据体重计算，体重7～15公斤者每次每公斤体重12毫克洛匹那韦和3毫克利托那韦、体重15～40公斤者每次每公斤体重10毫克洛匹那韦和2.5毫克利托那韦，均为每12小时1次。该药需要在进食时服用，这样不仅可以增加药物吸收还可以减少腹泻等不良反应。克力芝通过肝脏的一种酶叫细胞色素P450酶系统代谢，它同时还能抑制这种酶的功能，而治疗其它疾病的一些药物也通过这个酶代谢而被清除。这样，克力芝会影响这些药物的清除，造成这些药物浓度升高带来毒副作用，有时候有生命危险。所以克力芝不能和以下药物同时应用：阿司咪唑、特非那定、双氢麦角胺、麦角新碱、麦角胺、西沙比利、{XXX}、咪达唑仑等。患者就诊时一定要和医生讲明自己目前在服用的治疗其它疾病(除了艾滋病)的药物。血友病患者服用该药也要注意观察出血倾向，一旦发现问题应该及时就诊。克力芝胶囊和口服液需要冰箱冷藏保存(2℃～8℃)，室温下(最高25℃)可以保存2个月。
　　
　　9、阿巴卡韦
　　
　　阿巴卡韦是一种很好的抗病毒药物，今年2月份美国修订了艾滋病抗病毒治疗指南，对于初次治疗的患者来说阿巴卡韦也成了首选的抗病毒药物之一。个中缘由除了该药抗病毒效果和泰诺福韦相近，对线粒体损害小，从而脂肪消耗、胰腺炎、神经炎、乳酸酸中毒等不良反应就少之外，还在于用药前筛查超敏反应的基因HLA-B5701在国外应用于临床，阴性者应用该药后一般不会发生超敏反应，安全性大大提高。
　　
　　需要注意的是，第15届逆转录病毒和机会性感染国际会议上研究者报告，在过去6个月内服用阿巴卡韦会增加心肌梗塞的发生危险(另外一个药物去羟肌苷也是这样)。阿巴卡韦的制造商葛兰素威康公司发布了他们自己的研究结果，认为服用阿巴卡韦并没有增加心肌梗赛的危险。
　　
　　专家建议，由于西医药物具有一定的副作用，长期服用时会对身体产生一定的毒害作用，所以应尽量避免使用。艾滋病尚无最佳的治疗方法，所以做好预防工作更重要。

1, zidovudine

Zidovudine has been the preferred anti-HIV drugs, but the Americans earlier this year it dropped to second choice drugs. Why? Reasons; 1 Zidovudine side effects of bone marrow suppression, bone marrow and blood cells are produced, so zidovudine to reduce the impact of CD4 white blood cells (which is a kind of white blood cells) increase. Some patients say: I could not detect the virus, why CD4 cells look bad? Are many reasons, one of which you may be using zidovudine. 2 Zidovudine can also cause fat atrophy, although lighter than some of stavudine, but more than tenofovir and abacavir heavier. Americans therefore the tenofovir and abacavir as the preferred nucleoside drugs.

Zidovudine and lamivudine are often used together, these two drugs also made a one mixture. This is because when the virus resistant to lamivudine but after more sensitive to zidovudine.

2, stavudine

Stavudine, abbreviation d4T, 1994 in June in the United States. There are 2 forms of capsules and powder, the powder is used to configure the solution for the children are given. Note there are two kinds of capsules, each capsule contents were 15 mg and 20 mg, do not confuse. The same as taking didanosine, according to the weight of adult is taking. Weight greater than 40 mg per 60 kg body weight of less than 60 kg each 30 mg every 12 hours are 1. Some experts recommend no matter how many are at each weight 30 mg, taken once every 12 hours, thus reducing adverse reactions, and efficacy is not affected. However, this view has not been recognized.

3, lamivudine

Lamivudine, the English referred to 3TC, trade name Yi Ping-dimensional, in November 1995 was approved for AIDS anti-viral treatment.

In China, but it is well-known as a drug. GSK is the production of lamivudine with lamivudine, but lamivudine with lamivudine 100 mg per tablet, is used to treat chronic hepatitis B.

In the field of AIDS, it also called star drugs. The first anti-viral AIDS treatment programs in almost all contain the drug. Of course, the drug can also use another drug emtricitabine (the FTC) instead. The structure of these two drugs, mechanism of action, efficacy, resistance etc similar.

4, didanosine

Structure and the drug zidovudine, stavudine, lamivudine are different, so in general when these three kinds of viral drug resistance when didanosine can be spent instead. Also for this reason, China is currently the second-line drugs for didanosine, which is reasonable. Used as second-line drugs is not to say that drugs are not zidovudine and stavudine is good, I'd felt it, if not taken into account reserved for second-line drugs, then it should replace stavudine as first-line drugs. In the U.S., it and zidovudine are in the second best first-line treatment drugs.

5, nevirapine

Nevirapine: abbreviation NVP. There are two kinds of tablets and oral emulsion forms. Rather special way of taking it, there is a "run-in period." That is, start taking the first two weeks after it is run-in period, 1 time a day medication, dose 200 mg. If no significant adverse reactions within 2 weeks, 2 weeks after taking a day to 2 times per 200 mg. Adults taking method for the first two weeks once a day, 200 mg every 2 weeks to 12 hours a day 1, every 200 mg. Way of taking the children for the first two weeks once a day, each 120 mg / m3 body surface area (maximum of 200 mg each), 2 weeks to 12 hours, every 120 to 200 mg / m2 body surface area (maximum of 200 mg each). In the treatment of liver damage occurred after the first four months, then may also occur, but generally not serious.

If after taking nevirapine rash, and must contact a doctor or go to the doctor, especially rashes accompanied by fever, the more necessary to guard against. Severe skin rash (such as blisters, ulcers, peeling, mucosal damage, etc.) must be discontinued.

Its main side effects are rash and liver damage. Patients with high CD4 cell count (men> 400 / mm3, women> 250 / mm3) occurred at higher risk of liver damage. Therefore, not previously received antiretroviral therapy in patients with CD4 cell counts higher than if more than two threshold values, to avoid the application of nevirapine.

6, according to the non-Wei Lun

By non-Wei Lun: abbreviation EFV, trade name rather than applied, a non-nucleoside reverse transcriptase inhibitor, in September 1998 in the United States. There are two forms of capsules and tablets. 1 adult every night at bedtime, 600 mg each. Vary according to weight in pediatric patients taking different doses, as follows: 10 to 15 kg 200 mg every child, every 15 to 20 kg 250 mg, 20 to 300 mg every 25 children, 25 to 350 mg per 32.5 kg child , 32.5 - 40 kg 400 mg every child,> 40 kg dose of 600 children each. Is 1 day, at bedtime. 3 years of age or weighing less than 10 kg should not take children by non-Wei Lun, This is not because they can not take. Just because the current non-Wei Lun not by oral, children under 3 years old will not swallow capsules or tablets, and children weighing less than 10 kg of non-Wei Lun by taking the dose has not been studied, so it can not taking.

7, indinavir

Indinavir: abbreviation IDV, imported goods were good interest rate risk of drugs, protease inhibitors, in March 1996 in the United States, for the capsules. Method for each adult taking 800 mg every 8 hours. Does not recommend taking children abroad indinavir way, China's "AIDS treatment guidelines" recommended for children 500 mg / m2 body surface area (maximum of 800 mg each) every 8 hours. The drug requires an empty stomach. In addition, in order to avoid kidney stones, taking indinavir should drink lots of water, daily water intake for adults to reach at least 1.5 liters. Hemophilia patients need attention, indinavir can increase the risk of bleeding, so to avoid the application or in closely monitored applications. Other adverse reactions are mainly caused by metabolic abnormalities, such as high cholesterol, high cholesterol, high blood sugar, diabetes, fat accumulation, and so on.

8, Chris Chi

Chris Chi: it is ritonavir and lopinavir together these two protease inhibitors made in China, mainly in the form of capsules and oral solution, tablets overseas as well. Capsule in September 2000, October 2005 tablets in the U.S. market. Each capsule contains 133.3 mg lopinavir and 33.3 mg ritonavir per ml oral solution containing lopinavir 80 mg and 20 mg ritonavir. Method for adult patients taking three capsules each time, every 12 hours. Because each piece of content in large tablets, just 2 tablets every 12 hours followed by the can. Children were calculated according to weight, weight 7 to 15 kilograms per kg body weight 12 mg and ritonavir Crowe horses that 3 cents Keli Tuo Wei, weighing 15 to 40 kilograms each 10 mg per kilogram of body weight and 2.5 Crowe horses ritonavir cents Keli Tuo ritonavir, are each 12 hours. When taking the drug need to eat, not only to increase drug absorption also can reduce diarrhea and other adverse reactions. Chris Chi through the liver of an enzyme called cytochrome P450 enzyme system, metabolism, it also can inhibit the function of this enzyme, and the treatment of other diseases, some drugs are metabolism by this enzyme is cleared. This will affect the chocolate Chi clearance of these drugs, resulting in increased concentrations of these drugs caused side effects, sometimes life-threatening. So Chris Chi, and the following drugs can not be applied simultaneously: astemizole, terfenadine, ergotamine dihydrotestosterone, ergonovine, ergotamine, cisapride, {XXX}, midazolam and so on. Treatment when patients and doctors made it clear that we must take their current treatment in other diseases (except AIDS) drugs. Hemophilia patients taking the drug should also observe the bleeding tendency, once problems should be timely treatment. Chris Chi capsules and oral solution requires the refrigerator to save (2 ℃ ~ 8 ℃), at room temperature (up to 25 ℃) can be stored for 2 months.

9, abacavir

Abacavir is a good antiviral drugs, in February this year the United States revised its HIV antiretroviral treatment guidelines for initial treatment of patients with abacavir has become one of the preferred antiviral drugs. One reason in addition to antiviral effects and the drug tenofovir is similar to the mitochondrial damage, thereby helping to fat consumption, pancreatitis, neuropathy, lactic acidosis and other adverse reactions is small, but also screening for hypersensitivity before treatment is response genes HLA-B5701 clinical application in a foreign country, and negative application of the drug hypersensitivity does not occur after the general, security is greatly improved.

Note that, the 15th Retrovirus and Opportunistic Infections International Conference on researchers report in the past six months, taking abacavir may increase the incidence of myocardial infarction risk (another way of drug didanosine also ). Abacavir Glaxo Wellcome manufacturers released their own findings, that taking abacavir did not increase the risk of myocardial infarction event.

Experts suggest that, because Western medicine has some side effects, long-term use when the body will have some toxic effects, so should be avoided. There is no best treatment for AIDS, prevention is more important to do so.