Điều trị thuốc kháng virus ở những cá nhân đã sử dụng phác đồ dự phòng trước phơi nhiễm (PrEP) trước khi chẩn đoán
Tóm tắt
Các loại thuốc kháng retrovirus, tenofovir và emtricitabine, được sử dụng như một phác đồ dự phòng trước phơi nhiễm (PrEP), cũng được dùng trong điều trị HIV. Kháng thuốc do PrEP có thể khiến các lựa chọn điều trị trong tương lai bị ảnh hưởng. Bài đánh giá này thảo luận về việc điều trị những cá nhân đã sử dụng PrEP và có sự xuất hiện các đột biến virus chống lại tenofovir (K65R) hoặc emtricitabine (M184I/V).
Mặc dù chưa có nghiên cứu nào điều tra một cách hệ thống về phương pháp điều trị tối ưu cho những cá nhân đã sử dụng PrEP trước khi chẩn đoán, có bằng chứng giai thoại cho thấy HIV có K65R và/hoặc M184I/V có thể được điều trị thành công bằng cách sử dụng các phác đồ điều trị hàng đầu được khuyến nghị.
Sự kháng thuốc có thể xảy ra do việc sử dụng PrEP trong khi có nhiễm HIV cấp tính không được nhận ra, việc tuân thủ một phần phác đồ PrEP và sự lây truyền HIV kháng lại các thuốc PrEP. Việc điều trị bằng thuốc kháng retrovirus hàng đầu đối với những cá nhân đã sử dụng PrEP trước khi chẩn đoán cần được tối ưu hóa dựa trên kết quả xét nghiệm kháng gen. Những cá nhân có M184I/V và/hoặc K65R có thể được điều trị bằng các phác đồ dựa trên dolutegravir, bictegravir, hoặc darunavir cộng với tenofovir cộng với lamivudine hoặc emtricitabine. Việc điều trị kép sử dụng dolutegravir cộng với lamivudine không được khuyến nghị cho liệu trình điều trị khởi đầu ở những cá nhân có các đột biến virus chống lại các thuốc được sử dụng trong PrEP. Cần phải có một nghiên cứu cấp bách để xác nhận các bằng chứng giai thoại về điều trị thành công bằng cách sử dụng các phác đồ hàng đầu.
Từ khóa
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