Advances in Antiretroviral Therapy

摘要

The 2017 Conference on Retroviruses and OpportunisticInfections (CROI) featured exciting preclinical data oninvestigational antiretroviral agents with good in vitroefficacy and long half-lives. Investigational medications,including bictegravir, demonstrated excellent efficacyand tolerability, as did dual-agent therapy with dolutegravirpaired with rilpivirine or with lamivudine. Dolutegravirmonotherapy proved inadvisable due to virologicfailure and resistance. The gap between high- andlow-income settings along the HIV care continuum isnarrowing, with Zimbabwe, Malawi, and Zambia approachingthe 90-90-90 targets established by the jointUnited Nations Programme on HIV/AIDS (UNAIDS),whereas communities in the Southern United States arefalling behind. Innovative strategies to improve outcomesinclude 2-way text messaging, home-based HIVtesting, peer navigation, and New York City's realignmentof services into comprehensive sexual health programs.A high prevalence of resistance was documentedin low- and middle-income settings and policy considerationswere modeled to address increasing resistancerates. Novel resistance mutations to integrase strandtransfer inhibitors and nucleoside analogue reservetranscriptase inhibitors were identified, but the clinicalimplications are unclear and require further investigation.Several studies provided insights on dosing andsafety of antiretroviral therapy to prevent mother-tochildtransmission through pharmacokinetic analysis. Aspecial session devoted to Zika virus included a study ofits effects on the central nervous system and a promisinganimal study of a Zika vaccine.