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Document Details :

Title: Stand van zaken in verband met de therapie van aids
Author(s): DE CLERCQ E
Journal: Tijdschrift voor Geneeskunde
Volume: 64    Issue: 16   Date: 2008   
Pages: 807-813
DOI: 10.2143/TVG.64.16.2000375

Abstract :
Momenteel zijn er 23 anti-hiv-middelen door de US Food and Drug Administration (FDA) goedgekeurd. Zij vallen in 6 verschillende categorieën: nucleoside-“reverse”-transcriptaseremmers (NRTI’s): zidovudine, didanosine, zalcitabine, stavudine, lamivudine, abacavir, emtricitabine; nucleotide-“reverse”-transcriptaseremmers (NtRTI’s): tenofovirdisoproxilfumaraat; niet-nucleoside-“reverse”-transcriptaseremmers (NNRTI’s): nevirapine, delavirdine, efavirenz; proteaseremmers (PI’s): saquinavir, ritonavir, indinavir, nelfinavir, amprenavir, lopinavir, atazanavir, fosamprenavir, tipranavir, darunavir; coreceptorremmers (CRI’s): de CCR5-antagonist maraviroc; en fusieremmers (FI’s): enfuvirtide. Eerlang zullen hier wellicht andere NNRTI’s en ook integraseremmers (INI’s) bijkomen.
Bedoeling is deze anti-hiv-middelen gecombineerd toe te dienen. Zo werden tenofovirdisoproxilfumaraat, emtricitabine en efavirenz in één pil (oraal in te nemen 1 ≈ per dag) samengebracht.
Door dergelijke anti-hiv-middelencombinaties is aids van een acute dodelijke infectie geëvolueerd naar een chronische aandoening die goed behandelbaar is. Bij ontstentenis van een effectieve vaccinatie zou het profylactisch gebruik van één of meerdere anti-hiv-middelen, bv. tenofovirdisoproxilfumaraat al dan niet in combinatie met emtricitabine en efavirenz, ter bescherming tegen parenterale, seksuele en perinatale hiv-overdracht, dringend moeten overwogen worden.





State-of-the-art of the AIDS therapy
Currently 23 anti-HIV drugs have been approved by the US Food and Drug Administration (FDA). They are divided into 6 different categories: NRTIs (nucleoside reverse transcriptase inhibitors: zidovudine, didanosine, zalcitabine, stavudine, lamivudine, abacavir, emtricitabine), NtRTIs (nucleotide reverse transcriptase inhibitors: tenofovir disoproxil fumarate), NNRTIs (non-nucleoside reverse transcriptase inhibitors: nevirapine, delavirdine, efavirenz), PIs (protease inhibitors: saquinavir, ritonavir, indinavir, nelfinavir, amprenavir, lopinavir, atazanavir, fosamprenavir, tipranavir, darunavir), CRIs (co-receptor inhibitors: the CCR5 antagonist maraviroc) and FIs (fusion inhibitors: enfuvirtide). In the near future, other NNRTIs as well as INIs (integrase inhibitors) may be added to this list.
It is intended to combine the anti-HIV drugs. One such combination treatment regimen is based on tenofovir disoproxil fumarate, emtricitabine and efavirenz which have been combined in one single pill (to be taken orally once daily).
Due to the use of such drug combination regimens AIDS has evolved from an acute lethal infection to a well treatable chronic disease. In the abeyance of an effective vaccination, the prophylactic use of one or more anti-HIV drugs, i.e. tenofovir disoproxil fumarate, whether or not combined with emtricitabine and efavirenz, for protection against parenteral, sexual and perinatal HIV transmission should be strongly advocated.

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