艾滋病抗病毒药物的副用及其处理

1、steven-johnson 综合征发生在对复方新诺明过敏的病人身上。这种病通常比多型红斑严重。lipodystrophie10lipoatrophy tdf + 3tc + efv: 234200184183177175170d4t + 3tc + efv: 250211194182179170162 周周相对基准线的变化相对基准线的变化 (mg/dl) 1341tdf + 3tc + efvd4t + 3tc + efv9081035周周 48, 96, 144, p 0.001-20020406080100120140160024487296120144gallant je et al.

2、 jama. 2004;292:191-201.0102030ldlhdl相对极基线的平均变化相对极基线的平均变化 (mg/dl) tdf + 3tc + efv d4t + 3tc + efv *p 0.001*p = 0.003* 空腹总胆固醇空腹总胆固醇 : tdf 组和组和d4t 组相对于基线的均值增加分组相对于基线的均值增加分别为别为+30 mg/dl和和 +58 mg/dl (p 20% loss)efvlpv/rlpv/r + efvnrtis: 3tc + d4t, tdf or zdv(investigator-selected)10%n=1917%n=19721%n=188

3、17%n=1669%n=17332%n=17149haubrich r et al. aids 2009, (23) 1109-1128n=41n=43n=63n=73n=67n=50logistic regression week 96 lipoatrophymodel includes randomized arm and nrti, for nrti-containing regimens onlynrtis: 3tc + d4t, tdf or zdv(investigator-selected)tc+10+38*lipid changes at week 96startmrkldl-

4、c hdl-c trigly-cerides+7+21*+3+10*-4+40*raltegravir (n=281)efavirenz (n=282)+35*artemis+17+15+5+18+66*darunavir/r (n=343)lopinavir/r (n=348)+20+36castle+13+17+7+10+14+36atazanavir/r (n=441)lopinavir/r (n=437)tcldl-c hdl-c trigly-ceridestcldl-chdl-c trigly-cerides+8*p0.001; p=0.0102; and p 65-62-33-44-501-2 5 mmol/l或乳酸酸中毒或乳酸酸中毒停用线粒体毒性药物考虑维生素及nucleomaxx (36g tid 连续3天/月)停用nrtis及所有线粒体毒性药物加强监护保持hb 100 g/l避免应用缩血管药物吸氧纠正低血糖碳酸氢根有争议辅酶q10 (100 mg tid)维生素c (1 g tid)硫胺素(vit. b1, 100 mg tid)核