抗HIV治療ガイドライン　2012年3月

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1 Guideline

2 I I 1

3 I...4 1HIV...6 2HIV...8 1CD4T...8 2HIV RNA...8 3HIV HIV 13 3ARTHIV HIV HIVART.32 1HIV HIV : NRTI : NNRTI : PI : INSTI CCR HIV HIV NRTI NNRTI PI INSTI CCR HIVTDM NRTI NNRTI PI INSTI CCR HIV HIV.41 4Salvage HIV

4 ARTantiretroviral therapy AIDS HIV HIV ART HIV/HBVHBV Genotype A(Ae.102 3HIVHBV HBV HIV/HBVB HIVHBVHAV HIVHCV HIVHCV HCVHIV HIVHCV ALT ART HCV ART HIV/HCVHCV HIV/HCVHCV HIV HIV HIV HIV HIV HIV HIV HIV HIV I 3

5 µ 4 II II

6 II 5

7 III HIV3 AIDS AIDSAIDS HIVCD4T HIV RNA III ARTHIV AIDSART µ 6

8 III 7

9 III µµ µ 8

10 µ III 9

11 III 10

12 III 11

13 IV CD4T 350/µL BBHIV CD4THIV IV HIVCD4T350/µLAIDS HIV µ 12

14 µ IV µ µ µ µµµ µ µµ 13

15 IV µ µ µ µ 14

16 µ µ µ µ µ µµ µ µµ µµ µ µ µ µ µµ µ µ µ IV 15

17 µ µµµ µ IV 16 µ µ µ

18 µ µ µ µ IV 17 µ

19 IV 18

20 IV 19

21 IV 20

22 IV 21

23 V NRTI 2NNRTI 1NRTI 2PI 1 RTVNRTI 2INSTI V HIVHIV 22

24 V 23

25 V 24

26 V 25

27 V 26

28 V µ µ 27

29 V 28

30 V 29

31 V 30

32 V 31

33 V ABC+3TC+LPV/r TDF+FTC+LPV/r ABC+3TC+ATV r TDF+FTC+EFV ABC+3TC+LPV/r TDF+FTC+LPV/r ABC+3TC+ATV r TDF+FTC+EFV TDF+FTC+FPV rtv TDF+FTC+LPV/r ABC+3TC+ATV rtv TDF+FTC+EFV TDF+FTC+RAL TDF+FTC+FPV rtv TDF+FTC+LPV/r TDF+FTC+EFV ABC+3TC+DRV rtv TDF+FTC+DRV rtv TDF+FTC+RAL TDF+FTC+ATV rtv TDF+FTC+ATV rtv TDF+FTC+ATV rtv TDF+FTC+ATV rtv TDF+FTC+EFV TDF+FTC+ATV rtv 32

34 ï V 33

35 V ï ï 34

36 naïve ê V 35

37 VI HIVHIV RNA ARTHIV RNA 201,000/mL Blip VI HIV RNA A SalvageA SalvageHIV 32A Darunavir Raltegravir Etravirine 36

38 VI 37

39 µ VI 38

40 VI 39

41 VI 40

42 VI 41

43 VI TAM: thymidine anologue-associated mutations codon No A.A in wild type M A K D T K L V F V A L K K V V Y F E Q V Y M Y G L T K P M (AZT) L N R W Y/F Q/E (ddi) R V (d4t) L R N R W Y/F Q/E (FTC) (3TC) (ABC) R R R V F V/I V/I V (TDF) R E 151 complex 69 ins complex multi-nrti L L V I L V ins R N R Y M W Y/F Q/E W Y/F Q/E codon No A.A in wild type M A K D T K L V F V A L K K V V Y F E Q V Y M Y G L T K P M (NVP) I P N A/M I C/I C/L/H A (EFV) I P N M I C/I L S/A H (Etravirine) I G I E/H/P I A/G/K D/F/T C/I/V S/A L codon No (SQV)/r I/R/V (IDV)/r I/R/V (NFV) F/I (fapv)/r F/I/R/V (LPV/r) F/I/R/V (ATV)/r I/F/V/C (DRV)/r I A.A in wild type L V I G K L D V L E E M K M I G I F I Q D I L I E M/R M/R M/R/I/ T/V I I I I N I I I I I F I/F/V Q F I I I/L/V V I/L I/L I/L V I/L V/A I/L V V V/L V V L/V/M V L V/L/A/ M/T/S L L/V/M/ L/Y T/A V M/L E V V P L/M/V H A G T L V V N I I V/T S V/T S/A V/T S V/T S V/I/T/LC/S/T/A P V V V V I A/F/T/S I A/F/T I A/F/S/T A/F/S/T A/F/T/S A/T/F/I V V V V V V V V N L L I D/S S V M M M M M M L/M 42

44 VI AZT d4t TDF ABC ddi 3TC 184V R R, 184V L, 215Y L, 215Y, 184V L, 215Y, 210W L, 215Y, 210W, 184V NFV SQV IDV RTV APV LPV ATV 30N N, 90M N, 46I N, 46I, 90M

45 VI 44

46 VI naïve non-naïve 45

47 VI 46

48 VI 47

49 VI 48

50 ï VI 49

51 VI ä 50

52 VI 51

53 γ 52 VII VII

54 VII 53

55 VII 54

56 VII 55

57 VII 56

58 VII 57

59 VII 58

60 VII 59

61 VII 60

62 in vitro VII 61

63 VII 62

64 VII 63 µ

65 VII 64

66 VII µ 65

67 VII 66

68 VII 67

69 VIII HIVHIV HIV VIII HIV1,00047% 27% HIV HIV V-5 QOL γ 68

70 VIII 69

71 VIII 70

72 β VIII 71

73 VIII 72

74 VIII γ 73

75 VIII γ 74

76 VIII 75

77 Change in fatmass (g) (a) ABC TDF Change in fatmass (g) (b) ABC TDF Change in fatmass (g) (c) ABC TDF -200 Randomisation Week 24 Week Randomisation Week 24 Week Randomisation Week 24 Week 48 Moyle GJ, et al. AIDS 20: , 2006 VIII ï ø é 76

78 ø ï é VIII 77

79 VIII é éé 78

80 VIII 79

81 IX 1 IX 2HIVHIV 3CD450/µLHIV RNA10/mLHIV 4HIV HIV 6HIV 3 12HIV HIV DHHSCD4 200/µL24HIV 7NSAIDs HIV 80

82 IX 81

83 IX 82

84 µ µ IX 83

85 IX 84

86 IX 85

87 IX β 86

88 IX µ β 87

89 IX µ µ µ 88

90 IX 89

91 IX 90

92 ü IX 91

93 IX íó í ü 92

94 IX 93

95 X HIVHIV 1 2rifamycinHIV 3 3 X ART ART 94

96 X 95

97 X 96

98 X µ µ µ 97

99 X 98 µ µ

100 µ µ µ µ µ µ µ γ X 99

101 X öö 100

102 X 101

103 XI 1.HIVHBVHBV HBVHBV XI 2. HIVHBV HIVHBV HIVHIVHBsHBs HBcB A HBcHBV DNA occult HBV B 3.HBVHBVHIV23 HIVA 102

104 XI 103

105 XI α α 104

106 XI 105 α α

107 XI 106

108 α XI 107

109 naïve XI 108

110 XI 109

111 XII HCV DAADirect-Acting Antivirals HIV XII 110

112 µ µ XII µ 111

113 XII α 112

114 XII 113

115 XII µ µ 114

116 XII 115

117 XII 116

118 á XII 117

119 XII íáíéá óá 118

120 íóáá ííí áíó íéóíá Nuñez XII 119

121 XII äíáí í ä 120

122 áóí íáí éí α Neukam K, Camacho A, Caruz A, Rallón N, Torres-Cornejo A, Rockstroh JK, Macías J, Rivero A, Benito JM, López-Cortés LF, Nattermann J, Gómez-Mateos J, Soriano V, Pineda JA. Prediction of response to pegylated interferon plus ribavirin in HIV/hepatitis C virus (HCV)-coinfected patients using HCV genotype, IL28B variations, and HCV- RNA load. J Hepatol in press ü XII 121

123 XIII HIVHIV CIIIHIV XIII 122

124 XIII µ 123

125 XIII µ 124

126 XIII 125

127 XIV DNA PCR RT-PCR 2 XIV 2. CD4T5 CD4T 15CD425 5CD4500/µL HIV RNA10/mL 3. 1HIV RNACD4 HIV 4. HIVHIV3 genotype 126

128 XIV 127

129 XIV µ µ µ 128

130 XIV 129

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132 XIV 131

133 XIV 132

134 XIV 133

135 XIV 134

136 XIV 135

137 XIV 136

138 XIV 137

139 XIV 138

140 XIV 139

141 XV HIV 2 XV HIV HIV HIV SHEAThe Society for Healthcare Epidemiology of AmericaHIV 140

142 XV 141

143 XV 142

144 XV 143

145 XV 144

146 XV 145

147 XV 146

148 XV 147

149 XV 148

150 XV 149

151 XV 150

152 XV 151

153 152 XVI XVI

154 XVI 153

抗HIV治療ガイドライン 2012年3月

抗HIV治療ガイドライン　2012年3月