2004 12
4 5 5 5 5 6 7 7 7 7 7 7 8 8 8 8 HIV 8 8 9 9 9 9 10 HIV 10 14 10 10 10 11 12 13 13 14 14 14 15 18 18 1
18 19 HIV 19 20 21 22 25 26 26 27 28 28 30 30 31 31 31 32 33 33 33 34 35 35 35 36 37 37 38 40 72 74 2
WHO HIV 40 42 43 44 46 47 DOT 49 51 52 53 WHO 57 58 61 64 66 68 70 1 WHO HIV 10 2 11 3 13 4 NRTI 15 5 NNRTI 16 6 PI 17 7 HIV 19 8 HIV 22 9 24 10 24 25 11 26 12 29 13 30 14 31 15 32 16 32 17 WHO 34 18 35 19 CD4 36 20 38 3
2004 8 11 4
HIV 6 95% 95 50 HIV HIV 1. 1 ( ) 5
2 3 2. HIV 1 CD 4 2 3. 4. 5. 6. 1. 2. 3. 4. 5. 6
HIV TBHIV PEP HIV HIV FBO NGO 7
HIV HIV HIV HIV 2 HIV HIV HIV HIV HIV HIV HIV HIV HIV CD 4 CD 4 1 HIV CD 4 HIV CD 4 CD 4 200/mm 3 HIV 8
HIV 9
1. HIV 2. 3. HIV 14 HIV HIV HIV 18 18 3 1218 HIV HIV HIV PCR p24 HIV 4 HIV WHO III IV CD 4 <200/mm 3 1 2 CD 4 CD 4 TCL<1200/mm 3 CD 4 CD 4 1 WHO HIV WHO WHO WHO WHO 5%10% >10% HIV >5x - - - HIV WHO HIV WHO 10
2 WHO IV CD 4 < 200/mm 3 CD 4 200350/mm 3 >30% WHO III < 1200/mm 3 200/ mm 3 < CD 4 < 350/ mm 3 3 TLC TLC HIV HIV WHO III CD 4 > 200/mm 3 CD 4 HIV HIV EFV 11
2 2 1. 3 1 2. ( ) 95% 12
(3) 3 CD 4 HbSAgAnti-HCV X ALT AZT Hb EFV, IDV >12 D4T 13
11 2 HIV CD 4 HIV HIV NRTI NNRTI 14
4 5 6 4 NRTI / 2550100 60kg400 mg ddi 150200mg 55% 200mg 2 100167250 NRTI mg 250mg 125200250 < 60 kg 400 mg 250mg 125mg 167mg 150 mg300 150 mg 3TC mg 10 mg/ml 300mg NRTI 152030 >60 kg40 mg d4t 40 mg 1mg/ml <60kg30 mg 100 mg 300 mg AZT ZDV 300 mg 10mg/mL 10 mg/ml NRTI US HHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents 15
5 NNRTI 50100 600 mg EFV 200 mg [ EFV 600 mg 39% 79% ] 200 mg 200 mg NVP 50 mg/5 14 ml 200 mg 7% 4.3% 1.7% 3NNRTI Stevens-Johnson 52% 26% 2.6% 24 NNRT 16
6 PI 200 800 mg 8 IDV 333400 77 mg 1 2 800mg 100mg 100 mg 12 600mg RTV 600 15% mg/7.5 ml PI > 200% <30 CPK PI 12 300 mg 35 400 6 13 500 mg 14 600 mg 17
d4t + 3TC + NVP < 60 Kgd4T 30mg + 3TC 150 mg + NVP 200mg 2 > 60 Kgd4T 40mg + 3TC 150 mg + NVP 200mg 2 14 NVP 200mg 1 d4t/3tc/nvp d4t/3tc/nvp HIV d4t/3tc/nvp HIV CD 4 >250/mm 3 CD 4 >400/mm 3 NVP EFV NVP NVP NVP 2 NVP d4t+ddi+nvp AZT+ddI+NVP 3TC 3TC ddi ddi ddi/d4t CD4 > 250/mm 3 CD4 > 400/mm 3 NVP EFV EFV NVP NVP EFV 600mg 1 EFV EFV IDV/r 18
HIV 7 HIV 7 7 HIV CD 4 CD4 <200 mm 3 CD 4 200 350/mm 3 CD 4 >350 mm 3 CD 4 30% CD 4 <350 mm 3 CD 4 WHO IIIIV CD 4 CD 4 d4t+3tc 150 mg 2 +EFV(600mg) d4t+3tc 150 mg 2 +LPV/RTV (400/100 mg 2 ) d4t+3tc 150 mg 2 +ABC 300 mg 2 d4t+3tc 150 mg 2 +NVP d4t < 60 kg30 mg 2 > 60 kg40 mg 2 EFV 25% EFV 800 mg 25LPV 10 CD 4 >250mm 3 CD 4 >400/mm 3 NVP HIVTB HIV 3 HIV d4t AZT + 3TC + EFV600 800 mg/ EFV 25% EFV 800 mgabc300 mg 2 EFV 19
1. CD 4 <200/mm 3 HIV 2 2 2. HIV HIV X HIV 3 1. ALT>400 200<ALT<400 HCVHBVHAV TCM ALT 3 ALT 2. ALT ALT 400 ALT 200 400 HBV HCVHAV - HBV ALT - HCV ALT - ALT - NVP NVP NVP 57 NRTI 20
ALT EFV 1. HIV HIV HIV 2. 3 AZT + 3TC + NVP CD 4 <250/mm 3 AZT + 3TC + EFV CD 4 >250/mm 3 * VL>1000 /ml * * EFV VL AZT AZT NRTI AZT 3 >12 CD 4 CD 4 CD 4 HIV AZT VL > 1000 /ml VL > 1000 /ml CD 4 AZT VL 68 CD 4 CD 4 <350/mm 3 CD 4 >350/mm 3 3. HIV AZT d4td4t AZT CD 4 > 250/mm 3 NVP d4t ddi 21
4. EFV 3 EFV EFV NRTI d4tddi 5. NVPEFV PI 10 8 1 8 HIV CD 4 HIV CD 4 18HIVWHO CD 4 WHO CD 4 < 15% WHO I CD 4 < 15% 18HIVWHO CD 4 WHO < 1500/mm 3 CD 4 <15% 15 CD 4 <500/mm 3 6 CD 4 <200/mm 3 CD 4 CD 4 CD 4 CD 4 HIV 18 <2500/mm 3 18 <1500/mm 3 CD 4 HIV WHO I 22
2 * d4tazt+ 3TC +NVPEFV NNRTI 3 10kg NVP 3 10kg NVPEFV D4T :1 mg/kg 12 1 30mg AZT:160 mg/m 2 8 1 90 3TC :4 mg/kg 2 30 NVP :60 120 mg/m 2 1 14 8 7mgkg12 1 8 4 mgkg12 1 EFV : 10 < 15 kg200 mg 1 15 < 20 kg250 mg 1 20 < 25 kg300 mg 1 25 < 32.5 kg350 mg 1 3 EFV 3 ABC 30kg 0.035 + 0.1 30kg 30 0.02 + 1.05 d4t AZT+ 3TC + NNRTINVP EFV 3 EFV 3 10kg NVP NNRTI EFV NNRTI 3 SQV/r AZT3TCABC(SQV/r 23
ABC ) ABC SQV/r 25 kg 3 4 HIV HIV 6 PCP 18 HIV 18 HIV HIV 9 9 5 mgkg + 20 mgkg < 5 kg 2.5 ml 5 9.9 kg 5 ml 10 14.9 kg 7.5 ml 15 21.9 kg 10 ml 1 > 22 kg 15 ml 1.5 HIV 1 HIV HIV 5 24
24 10 10 24 CD 4 CD 4 6 CD 4 CD 4 CD 4 6 CD 4 50 CD 4 CD 4 HAART 3 / HIV HIV / d4t + 3TC + NVP 25
11 11 0.5 1 2 3 6 12 18 24 - - - - - - - - - - - - - - CD 4 + - - - HbSAgAnti-HCV - - - - - - - - X - - - - - - - - ALT AZT Hb - D4t ddi - - - - D4T ddi - - - NVP EFV IDV D4T ALT - - ALT - - - - - - - - - - - - - - - - - - - - - - - - - - CHOTGLDH _ - - - _ - - - - - - 26
1. 2. 3. 27
6 12 d4t AZT NVP EFV 12 13 28
12 3TC ddiazt 3TC NVPEFV ddid4t 3 EFV EFV EFV ddid4t AZT HIV 29
13 d4tddi HIV d4t d4tpi d4t ddi ddi AZT EFV AZT NVP NVPAZT EFV Hb HCT >25% d4t AZT * Stevens- Johnson ALT ddi AZT 2 ddi ddi 3TC 2 30
() AZT 4 Hb Hct Hb Hct >25% AZT d4t HIV CD 4 EFV NVP 3 14 14 12 34 S-J NVP 1 2 200mg NVP 1 2 ALT NVP 3 4 HIV S-J NVP EFV NVP 15 NVP 4 ALT AST>200 ALT EFV ALT >200 ALT ALT 1014 ALT ALT > 400 31
EFV HBsAg+HCV-Ab+ 15 1 ALT 51100 U/L SGPT 2 101200 U/L 3 201400 U/L 4 >400 U/L ddi d4t 3 HIV CMV CD 4 16 16 1 2 3 4 d4t ddi B 3 4 3 50 mg 150 3 32
d4t 3 3 4 d4t NRTI ddc NRTI d4t ddi 89 PI PI NNRTI TDF ABC Na + Cl - + HCO - 3 = 12 16 d4tddi NRTI d4t ddi ddi + d4t 400 CT MRI NRTI ART ddid4t ddc d4t d4t 33
CD 4 3 HIV / 4 6 WHO 17 17 WHO D4T3TC d4t d4t AZT NVP d4t d4t AZT TDF ABC NVP NVP EFV NVP EFV AZT3TC NVP D4T3TC EFV AZT3TC EFV NVP S-J NVP LPV/r SQV/r IDV/r NFV AZT d4t NVP NVP EFV NVP EFV NFVLPV/rABC NVP S-J NVP LPV/r SQVRIT IDV/r NFV d4t d4t AZT d4t d4t AZT TDF ABC EFV NVP AZT d4t EFV NVP 34
18 18 [ 10 ] 3 3 1. 3 2. CD 4 CD 4 3. CD 4 35
CD 4 19 CD 4 19 CD 4 CD 4 CD 4 CD 4 CD 4 HIV WHO HIV >50% CD 4 / HIV CD 4 CD 4 NVPEFV NNRTI 2555 NRTI ddid4t3tcazt 17 NVPEFV NNRTI 57 NRTI CD 4 CD 4 36
NRTI NRTI IDV NRTI IDV RTV NRTI TDFABCWHO TDFABC NRTI AZT + 3TC ABC + ddi D4T ZDV ABC + + 3TC ddi + NNRTI NVP EFV + PI LPV/r NFV 25kg SQV/r 37
95 20 20 3 95% 100% 90-95% 64% 80-90% 50% 70-80% 25% <70% 6% 1. HIV 2 38
2.HIV HIV >95% HIV HIV HIV HIV 39
WHO HIV WHO HIV 1. 2. 1 3., < 10% 4. 5. 5 6. 2 7. > 10% 8. > 1 9. ( ) > 1 10. ( ) 11. 12. 13. (, ) 3 / <50% 14.HIV 1 15. 16. 17. >1 18. 19. CMV 20. >1, 21. 22. 23. 24. 25. 26. 27. 28. 40
29.HIV (2) 4 / >50% : (1) HIV : >10%, 1 (2) HIV / HIV WHO HIV 1. 2. 3., > 30 4. 5. 6. > 30 7. [ ] 8.AIDS 9. * 10. 11. 12. * > 10% 1 2 5 41
VCT WHO CD4 TB/HIV 42
2 ( ) 2 ( EFV) 2 ( ) IDV ( EFV) ALT Hb ALT > 200 ALT > 400-43 -
6 48 EFV 3-44 -
- 45 -
95 1 1 2 3 4 5 3 2 1 2 2 2 1 2-46 -
HIV HIV HIV HIV HIV HIV - 47 -
2 HIV HIV HIV - 48 -
DOT DOT 4 1015 10 3 HIV - 49 -
4-50 -
1. 1 2 3 4 2. 1 - - - - 2 3-51 -
- 52 -
NRTIs (AZT) (d4t) (ddi) d4t 27% ddi ddi AUC 63% ddi ddi AZT ddi (IDV) ddi IDV IDV AUC ddi 1hr IDV + ( ) (GCV) ddi + GCV ddi AUC 111% GCV AUC 21% ddi GCV AUC - - 53 -
NNRTI (NVP) (EFV) 63% NVP 15-30% NVP 20%-58% EFV 25%. EFV 800 mg qd. NVP 26%. 30%. 39%. 20% 37% NVP - 54 -
PI (IDV) * (RTV) IDV68% IDV 600 mg tid 3X 200 mg * IDV ( )89%IDV ( RTV 35% )87% RTV PI 53% 77% 26% 24% 40% (ATO) AUC SQV/RTV 450% SQV/RTV 50% IDV AUC RTV 37% AUC 3 AUC 11 48 25mg 48 25mg IDV 26% C >/= 1 / IDV AUC 14%Cmin32% 145% AUC 60% IDV ( ) 47% 600 mg TID 200mg 2 RTV RTV AUC - Cmin - 55 -
PI (SQV) (LPV) SQV 3X LPV AUC 13% 3 >200 mg/ 200 SQV 84%. RTV+SQV LPV AUC 75% LPV/r SQV/RTV 400/400 mg BID 600 mg qd 3x/ 45%. SQV 177%. AUC 77% 42%. (ATO) SQV/RTV 450% AUC 5.88 SQV/RTV 50% AUC 33% SQV RTV LPV, RTV, AUC 20% SQV/RTV 400/400 mg BID AUC 53% PI AUC 2 25 RTV AUC 11 mg 48 25mg SQV SQV RTV RTV RTV AUC - RTV-SQV LPV-RTV RTV RTV 400mg LPV/RTV 800/200mg LPV 28% LPV - 56 -
WHO WHO 3 d4t AZT TDF ABC + + 3TC ddi (1) + + NVP EFV LPV/r SQV/r (2) (1) TDF ddi 400 mg 250 mg (2) LPV/r SQV/r NFV d4t AZT ABC + + 3TC ddi + + 1 NNRTI (NVP EFV) 1 PI LPV/r NFV, SQV/r > 25 kg - 57 -
5 010-8315669283156526 1.3 cm DataFax 0 3 7 00 7 007-58 -
- 59 -
( ) DataFax 2 0 0 4 0 2 (NRTI)01~39 01 AZT,ZDV 011 012 02 d4t 021 022 03 ddi 031 032 04 3TC 041 042 05 AZT+3TC 051 052 (NNRTI) 41-69 41 (EFV ) 411 412 42 (NVP) 421 422 71-99 71 711 712-60 -
NO. 1 4 2 4 CDC 0001 00020003 9999 3 5 2 2 3 2003 1 03 001 4 1 5 2 6 1 7 9 7 1 8 9 8 4 9.1 8 4 +2 +2 9.2 1 9.3 1 9.4 1 9.5a 1 9.5e 10.1 4 3 1 0 10.2 11 12 8 13 12 3 000-61 -
- 62 -
- 63 -
0.5 ±2 1 1 ±2 2 2 ±3 3 3 3 4 6 5 5 9 5 6 12 5 7 0.512361218 0.512361218 NO. 3 001 999 1 1 5 2 4 3 4 4 8 8 4 +2 +2 5 4 1 0 6 6 7 1-64 -
- 65 -
NO. 1 2 3 4 3 6 4 8 1 4 1 AIDS 1 ARV / - 66 -
- 67 -
99 NO. 1 6 GB 2 4 0001 00020003 9999 3 12 000 4 12 000 5 1 ARV / 6 ` 2 90 90 99-68 -
- 69 -
( ) Logic 1 ( ), 2 % 3 % 1 AIDS 2 3 VCT % 4 % 5 6 6 % 7 % - 70 -
1 % 2 ARV % 3 DOTS % 4 % 5 ARV VCT % 6 ARV % 7 % 8 % 9 % 10 % 11 % 12 % 13 % 14 % 1 2 % 1HIV/AIDS % 2HIV/AIDS % - 71 -
AIDS ALT ART ARV AZT BID CBC CDC CD 4 HIV CMV CNS d4t ddi DOT EFV HAV HBV HCV HIV Hb IDV IDV/r IEC IRS 3TC NGO NRTI NNRTI NVP OI PEP PCP PHA HIV PI PMTCT QD RIT or /r STD TB TCM - 72 -
TLC VCT VL WHO - 73 -
302-74 -
WHO Clinton Foundation Institute of Human Virology Project Hope MSF USCDC GAP UNAIDS - 75 -