В статье представлен обзор клинических рекомендаций по современной антиретровирусной терапии. В настоящее время современные предпочтительные схемы антиретровирусной терапии 1-й линии представляют собой комбинации 2 или 3 антиретровирусных препаратов (АРВП) в одной таблетке с кратностью приема 1 раз в сутки и, как правило, включают препараты II поколения (ингибиторы интегразы или ненуклеозидные ингибиторы обратной транскриптазы). Эти схемы обладают высокой эффективностью и хорошим генетическим барьером при развитии мутаций резистентности ВИЧ. Ингибиторы протеазы ВИЧ используют в качестве альтернативных режимов. Преимущества имеют схемы с наименьшим количеством и спектром побочных эффектов, отсутствием влияния на метаболические процессы и минимальными лекарственными взаимодействиями. Переключение пациентов на инъекционные режимы терапии с кратностью введения препаратов 1 раз в 2 месяца позволяет существенно повысить качество жизни пациентов и, соответственно, приверженность их лечению. Разработка и внедрение в клиническую практику АРВП новых классов обеспечивает подавление репликации ВИЧ у большинства пациентов, имеющих штаммы ВИЧ, устойчивые к препаратам основных групп АРВП (нуклеозидные ингибиторы обратной транскриптазы, ненуклеозидные ингибиторы обратной транскриптазы, ингибиторы протеазы, ингибиторы интегразы).
The article presents an overview of clinical recommendations for currant antiretroviral therapy. Currently, the current preferred first-line antiretroviral therapy regimens are combinations of 2 or 3 antiretroviral drugs (ARVs) in one tablet with a frequency of administration 1 time per day and, as a rule, include drugs of the 2nd generation (integrase inhibitors or non-nucleoside reverse transcriptase inhibitors). These schemes have high efficiency and a good genetic barrier in the development of HIV resistance mutations. HIV protease inhibitors are used as alternative regimens. Schemes with the least number and spectrum of side effects, no effect on metabolic processes and minimal drug interactions have advantages. Switching patients to injectable therapy regimens with a frequency of administration of drugs once every 2 months can significantly improve the quality of life of patients and, accordingly, adherence to their treatment. The development and introduction of new classes of ARVs into clinical practice ensures the suppression of HIV replication in most patients with HIV strains resistant to drugs of the main groups of ARVs (nucleoside/nucleotide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, integrase inhibitors).
Keywords: HIV infection, antiretroviral therapy, currant treatment regimens, causes of ineffective therapy
1. О состоянии санитарно-эпидемиологического благополучия населения в Российской Федерации в 2021 году. Государственный доклад. М.: Федеральная служба по надзору в сфере защиты прав потребителей и благополучия человека, 2022. Режим доступа: https://www.rospotrebnadzor.ru/documents/details.php?ELEMENT_ID=21796. Ссылка активна на 21.11.2023 [O sostoianii sanitarno-epidemiologicheskogo blagopoluchiia naseleniia v Rossiiskoi Federatsii v 2021 godu. Gosudarstvennyi doklad. Moscow: Federal'naia sluzhba po nadzoru v sfere zashchity prav potrebitelei i blagopoluchiia cheloveka, 2022. Available at: https://www.rospotrebnadzor.ru/documents/details.php?ELEMENT_ID=21796. Accessed: 21.11.2023 (in Russian)].
2. ВИЧ-инфекция и СПИД (Серия «Национальное руководство»). 2-е изд., перераб. и доп. Под ред. В.В. Покровского. М.: ГЭОТАР- Медиа, 2020 [VICh-infektsiia i SPID (Seriia «Natsional'noe rukovodstvo»). 2-e izd., pererab. i dop. Pod red. VV Pokrovskogo. Moscow: GEOTAR-Media, 2020 (in Russian)]. DOI:10.33029/9704-3-2020-VIC-1-696
3. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Developed by the HHS Panel on Antiretroviral Guidelines for Adults and Adolescents – A Working Group of the NIH Office of AIDS Research Advisory Council (OARAC). March 23, 2023. Available at: www.AIDSinfo.nih.gov. Accessed: 21.11.2023.
4. Guidelines for the Clinical Management and Treatment of HIV-infected Adults in Europe. Version 11.1. October, 2022. European AIDS Clinical Society. Available at: http://www.eacsociety.org. Accessed: 21.11.2023.
5. Покровский В.В., Юрин О.Г., Кравченко А.В., и др. Рекомендации по лечению ВИЧ-инфекции и связанных с ней заболеваний, химиопрофилактике заражения ВИЧ. Эпидемиология и инфекционные болезни. Актуальные вопросы. 2022;12(S4):3-107 [Pokrovsky VV, Yurin OG, Kravchenko AV, et al. Recommendations for the treatment of HIV infection and related diseases, chemoprophylaxis of HIV infection. Epidemiology and Infectious Diseases. Current Issues. 2022;12(S4):3-107 (in Russian)].
6. INSIGHT START Study Group; Lundgren JD, Babiker AG, Gordin F, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795-807. DOI:10.1056/NEJMoa1506816
7. TEMPRANO ANRS 12136 Study Group; Danel C, Moh R, Gabillard D, et al. A trial of early antiretrovirals and isoniazid preventive therapy in Africa. N Engl J Med. 2015;373(9):808-22. DOI:10.1056/NEJMoa1507198
8. European Association for the Study of the Liver; Pawlotsky J-M, Negro F, Aghemo A, et al. EASL recommendations on treatment of hepatitis C: Final update of the series. J Hepatol. 2020;73(5):1170-218. DOI:10.1016/j.jhep.2020.08.018
9. Рахманова А.Г., Кравченко А.В. Первый, зарегистрированный в Российской Федерации, комбинированный антиретровирусный препарат с приемом один раз в сутки. ВИЧ-инфекция и иммуносупрессии. 2014;6(3):78-85 [Rakhmanova AG, Kravchenko AV. He first antiretroviral drug combination licensed for STR use in the Russian Federation. HIV Infection and Immunosuppressive Disorders. 2014;6(3):78-85 (in Russian)]. DOI:10.22328/2077-9828-2014-6-3-78-85
10. Кравченко А.В., Орлова-Морозова Е.А., Шимонова Т.Е., и др. Эффективность и безопасность нового российского ненуклеозидного ингибитора обратной транскриптазы элсульфавирина в первой линии лечения ВИЧ-инфекции в комбинации с двумя нуклеозидными/нуклеотидными ингибиторами обратной транскриптазы – исследование 96 недель. Журнал инфектологии. 2018;10(2):76-82 [Kravchenko AV, Orlova-Morozova EA, Shimonova TE, et al. Efficacy and safety of novel Russian non-nucleoside reverse transcriptase inhibitor elsulfavirine in combination with 2 nucleoside/nucleotide reverse transcriptase inhibitors in first-line HIV treatment – 96-week study. Journal Infectology. 2018;10(2):76-82 (in Russian)]. DOI:10.22625/2072-6732-2018-10-2-76-82
11. Кравченко А.В., Покровская А.В., Куимова У.А., и др. Результаты лечения больных ВИЧ-инфекцией отечественной схемой АРТ в течение 60 недель. Эпидемиология и инфекционные болезни. Актуальные вопросы. 2021;11(3):90-5 [Kravchenko AV, Pokrovskaya AV, Kuimova UA, et al. Results of treatment of patients with HIV infection with the domestic ART scheme for 60 weeks. Epidemiology and infectious diseases. Current Issues. 2021;11(3):90-5 (in Russian)]. DOI:10.18565/epidem.2021.11.3.90-5
12. Кравченко А.В., Юрин О.Г., Покровская А.В. 25 лет применения отечественных оригинальных антиретровирусных препаратов в схемах первой линии терапии ВИЧ-инфекции. Инфекционные болезни: новости, мнения, обучение. 2023;12(2):75-82 [Kravchenko AV, Yurin OG, Pokrovskaya AV. 25 years of the use of domestic original antiretroviral drugs in first-line ART regimens of HIV-infection. Infectious Diseases: News, Opinions, Training. 2023;12(2):75-82 (in Russian)]. DOI:10.33029/2305-3496-2023-12-2-75-82
13. Molina JM, Orkin Ch, Cahn P, et al. Safety and Efficacy of Doravirine in Treatment-Naïve Adults with HIV-1: 4 Years of Experience From the DRIVE-FORWARD and DRVIVE-AHEAD Clinical Trials. 192-week Data. Oral Presentation EACS 2021. Available at: https://natap.org/2021/EACS/EACS_16.htm. Accessed: 21.11.2023.
14. Кравченко А.В., Кириченко А.А., Киреев Д.Е., Беляева В.В. Резистентность ВИЧ к антиретровирусной терапии. М.: ГЭОТАР-Медиа, 2023 [Kravchenko AV, Kirichenko AA, Kireev DE, Beliaeva VV. Rezistentnost' VICh k antiretrovirusnoi terapii. Moscow: GEOTAR-Media, 2023 (in Russian)]. DOI:10.33029/9704-7620-8-RAT-2023-1-112
15. Orkin C, DeJesus E, Khanlou H, et al. Final 192-week efficacy and safety of once-daily Darunavir/Ritonavir compared with Lopinavir/Ritonavir in HIV-1-infected treatment-naive Patients in the ARTEMIS trial. HIV Med. 2013;14(1):49-59. DOI:10.1111/j.1468-1293.2012.01060.x
16. Lennox JL, Landovitz RJ, Ribaudo HJ, et al; ACTG A5257 Team. Efficacy and tolerability of 3 nonnucleoside reverse transcriptase inhibitor-sparing antiretroviral regimens for treatment-naive volunteers infected with HIV-1: a randomized, controlled equivalence trial. Ann Intern Med. 2014;161(7):461-71. DOI:10.7326/M14-1084
17. Molina JM, Clotet B, van Lunzen J, et al. Once-daily dolutegravir versus darunavir plus ritonavir for treatment-naive adults with HIV-1 infection (FLAMINGO): 96-week results from a randomised, open-label, phase 3b study. Lancet HIV. 2015;2(4):e127-36. DOI:10.1016/S2352-3018(15)00027-2
18. Raffi F, Jaeger H, Quiros-Roldan E, et al. Once-daily dolutegravir versus twice-daily raltegravir in antiretroviral-naive adults with HIV-1 infection (SPRING-2 study): 96 week results from a randomised, double-blind, non-inferiority trial. Lancet Infect Dis. 2013;13(11):927-35. DOI:10.1016/S1473-3099(13)70257-3
19. Walmsley S, Baumgarten A, Berenguer J, et al. Brief Report: Dolutegravir Plus Abacavir/Lamivudine for the Treatment of HIV-1 Infection in Antiretroviral Therapy-Naive Patients: Week 96 and Week 144 Results From the SINGLE Randomized Clinical Trial. JAIDS J Acquir Immune Defic Syndr. 2015;70(5):515-9. DOI:10.1097/QAI.0000000000000790
20. Stellbrink HJ, Arribas JR, Stephens JL, et al. Co-formulated bictegravir, emtricitabine, and tenofovir alafenamide versus dolutegravir with emtricitabine and tenofovir alafenamide for initial treatment of HIV-1 infection: week 96 results from a randomised, double-blind, multicentre, phase 3, non-inferiority trial. Lancet HIV. 2019;6(6):e364-72.
DOI:10.1016/S2352-3018(19)30080-3
21. Wohl DA, Yazdanpanah Y, Baumgarten A, et al. Bictegravir combined with emtricitabine and tenofovir alafenamide versus dolutegravir, abacavir, and lamivudine for initial treatment of HIV-1 infection: week 96 results from a randomised, double-blind, multicentre, phase 3, non-inferiority trial. Lancet HIV. 2019;6(6):e355-63. DOI:10.1016/S2352-3018(19)30077-3
22. Cahn P, Sierra Madero J, Arribas JR, et al. Three-year durable efficacy of dolutegravir plus lamivudine in antiretroviral therapy – naive adults with HIV-1 infection. AIDS.
2022;36(1):39-48. DOI:10.1097/QAD.0000000000003070
23. Swindells S, Andrade-Villanueva JF, Richmond GJ, et al. Long-acting cabotegravir and rilpivirine for maintenance of HIV-1 suppression. N Engl J Med. 2020;382(12):1112-23. DOI:10.1056/NEJMoa1904398
24. Jaeger H, Overton ET, Richmond G, et al. Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with HIV-1 infection (ATLAS-2M), 96-week results: a randomised, multicentre, open-label, phase 3b, non-inferiority study. Lancet HIV. 2021;8(11):e679-89. DOI:10.1016/ S2352-3018(21)00185-5
25. Peluso MJ, Ferretti F, Peterson J, et al. Cerebrospinal fluid HIV escape associated with progressive neurologic dysfunction in patients on antiretroviral therapy with well controlled plasma viral load. AIDS. 2012;26(14):1765-74. DOI:10.1097/qad.0b013e328355e6b2
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1. O sostoianii sanitarno-epidemiologicheskogo blagopoluchiia naseleniia v Rossiiskoi Federatsii v 2021 godu. Gosudarstvennyi doklad. Moscow: Federal'naia sluzhba po nadzoru v sfere zashchity prav potrebitelei i blagopoluchiia cheloveka, 2022. Available at: https://www.rospotrebnadzor.ru/documents/details.php?ELEMENT_ID=21796. Accessed: 21.11.2023 (in Russian).
2. VICh-infektsiia i SPID (Seriia «Natsional'noe rukovodstvo»). 2-e izd., pererab. i dop. Pod red. VV Pokrovskogo. Moscow: GEOTAR-Media, 2020 (in Russian).
DOI:10.33029/9704-3-2020-VIC-1-696
3. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Developed by the HHS Panel on Antiretroviral Guidelines for Adults and Adolescents – A Working Group of the NIH Office of AIDS Research Advisory Council (OARAC). March 23, 2023. Available at: www.AIDSinfo.nih.gov. Accessed: 21.11.2023.
4. Guidelines for the Clinical Management and Treatment of HIV-infected Adults in Europe. Version 11.1. October, 2022. European AIDS Clinical Society. Available at: http://www.eacsociety.org. Accessed: 21.11.2023.
5. Pokrovsky VV, Yurin OG, Kravchenko AV, et al. Recommendations for the treatment of HIV infection and related diseases, chemoprophylaxis of HIV infection. Epidemiology and Infectious Diseases. Current Issues. 2022;12(S4):3-107 (in Russian).
6. INSIGHT START Study Group; Lundgren JD, Babiker AG, Gordin F, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795-807. DOI:10.1056/NEJMoa1506816
7. TEMPRANO ANRS 12136 Study Group; Danel C, Moh R, Gabillard D, et al. A trial of early antiretrovirals and isoniazid preventive therapy in Africa. N Engl J Med. 2015;373(9):808-22. DOI:10.1056/NEJMoa1507198
8. European Association for the Study of the Liver; Pawlotsky J-M, Negro F, Aghemo A, et al. EASL recommendations on treatment of hepatitis C: Final update of the series. J Hepatol. 2020;73(5):1170-218. DOI:10.1016/j.jhep.2020.08.018
9. Rakhmanova AG, Kravchenko AV. He first antiretroviral drug combination licensed for STR use in the Russian Federation. HIV Infection and Immunosuppressive Disorders. 2014;6(3):78-85 (in Russian). DOI:10.22328/2077-9828-2014-6-3-78-85
10. Kravchenko AV, Orlova-Morozova EA, Shimonova TE, et al. Efficacy and safety of novel Russian non-nucleoside reverse transcriptase inhibitor elsulfavirine in combination with 2 nucleoside/nucleotide reverse transcriptase inhibitors in first-line HIV treatment – 96-week study. Journal Infectology. 2018;10(2):76-82 (in Russian).
DOI:10.22625/2072-6732-2018-10-2-76-82
11. Kravchenko AV, Pokrovskaya AV, Kuimova UA, et al. Results of treatment of patients with HIV infection with the domestic ART scheme for 60 weeks. Epidemiology and infectious diseases. Current Issues. 2021;11(3):90-5 (in Russian). DOI:10.18565/epidem.2021.11.3.90-5
12. Kravchenko AV, Yurin OG, Pokrovskaya AV. 25 years of the use of domestic original antiretroviral drugs in first-line ART regimens of HIV-infection. Infectious Diseases: News, Opinions, Training. 2023;12(2):75-82 (in Russian). DOI:10.33029/2305-3496-2023-12-2-75-82
13. Molina JM, Orkin Ch, Cahn P, et al. Safety and Efficacy of Doravirine in Treatment-Naïve Adults with HIV-1: 4 Years of Experience From the DRIVE-FORWARD and DRVIVE-AHEAD Clinical Trials. 192-week Data. Oral Presentation EACS 2021. Available at: https://natap.org/2021/EACS/EACS_16.htm. Accessed: 21.11.2023.
14. Kravchenko AV, Kirichenko AA, Kireev DE, Beliaeva VV. Rezistentnost' VICh k antiretrovirusnoi terapii. Moscow: GEOTAR-Media, 2023 (in Russian).
DOI:10.33029/9704-7620-8-RAT-2023-1-112
15. Orkin C, DeJesus E, Khanlou H, et al. Final 192-week efficacy and safety of once-daily Darunavir/Ritonavir compared with Lopinavir/Ritonavir in HIV-1-infected treatment-naive Patients in the ARTEMIS trial. HIV Med. 2013;14(1):49-59. DOI:10.1111/j.1468-1293.2012.01060.x
16. Lennox JL, Landovitz RJ, Ribaudo HJ, et al; ACTG A5257 Team. Efficacy and tolerability of 3 nonnucleoside reverse transcriptase inhibitor-sparing antiretroviral regimens for treatment-naive volunteers infected with HIV-1: a randomized, controlled equivalence trial. Ann Intern Med. 2014;161(7):461-71. DOI:10.7326/M14-1084
17. Molina JM, Clotet B, van Lunzen J, et al. Once-daily dolutegravir versus darunavir plus ritonavir for treatment-naive adults with HIV-1 infection (FLAMINGO): 96-week results from a randomised, open-label, phase 3b study. Lancet HIV. 2015;2(4):e127-36. DOI:10.1016/S2352-3018(15)00027-2
18. Raffi F, Jaeger H, Quiros-Roldan E, et al. Once-daily dolutegravir versus twice-daily raltegravir in antiretroviral-naive adults with HIV-1 infection (SPRING-2 study): 96 week results from a randomised, double-blind, non-inferiority trial. Lancet Infect Dis. 2013;13(11):927-35. DOI:10.1016/S1473-3099(13)70257-3
19. Walmsley S, Baumgarten A, Berenguer J, et al. Brief Report: Dolutegravir Plus Abacavir/Lamivudine for the Treatment of HIV-1 Infection in Antiretroviral Therapy-Naive Patients: Week 96 and Week 144 Results From the SINGLE Randomized Clinical Trial. JAIDS J Acquir Immune Defic Syndr. 2015;70(5):515-9. DOI:10.1097/QAI.0000000000000790
20. Stellbrink HJ, Arribas JR, Stephens JL, et al. Co-formulated bictegravir, emtricitabine, and tenofovir alafenamide versus dolutegravir with emtricitabine and tenofovir alafenamide for initial treatment of HIV-1 infection: week 96 results from a randomised, double-blind, multicentre, phase 3, non-inferiority trial. Lancet HIV. 2019;6(6):e364-72.
DOI:10.1016/S2352-3018(19)30080-3
21. Wohl DA, Yazdanpanah Y, Baumgarten A, et al. Bictegravir combined with emtricitabine and tenofovir alafenamide versus dolutegravir, abacavir, and lamivudine for initial treatment of HIV-1 infection: week 96 results from a randomised, double-blind, multicentre, phase 3, non-inferiority trial. Lancet HIV. 2019;6(6):e355-63. DOI:10.1016/S2352-3018(19)30077-3
22. Cahn P, Sierra Madero J, Arribas JR, et al. Three-year durable efficacy of dolutegravir plus lamivudine in antiretroviral therapy – naive adults with HIV-1 infection. AIDS.
2022;36(1):39-48. DOI:10.1097/QAD.0000000000003070
23. Swindells S, Andrade-Villanueva JF, Richmond GJ, et al. Long-acting cabotegravir and rilpivirine for maintenance of HIV-1 suppression. N Engl J Med. 2020;382(12):1112-23. DOI:10.1056/NEJMoa1904398
24. Jaeger H, Overton ET, Richmond G, et al. Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with HIV-1 infection (ATLAS-2M), 96-week results: a randomised, multicentre, open-label, phase 3b, non-inferiority study. Lancet HIV. 2021;8(11):e679-89. DOI:10.1016/ S2352-3018(21)00185-5
25. Peluso MJ, Ferretti F, Peterson J, et al. Cerebrospinal fluid HIV escape associated with progressive neurologic dysfunction in patients on antiretroviral therapy with well controlled plasma viral load. AIDS. 2012;26(14):1765-74. DOI:10.1097/qad.0b013e328355e6b2
Авторы
А.В. Кравченко*, В.В. Малеев
ФБУН «Центральный научно-исследовательский институт эпидемиологии» Роспотребнадзора, Москва, Россия
*alexey-kravtchenko@yandex.ru