基于CD4^+T淋巴细胞计数标准的抗病毒治疗三十年的探索

Exploration of CD4+T cell counts based on antiretroviral therapy over the past three decades

＂何时开始抗反转录病毒治疗（ART）＂一直是一个国际指南不断探索的问题。在ART问世后的三十年里,这一研究经历了漫长的探索,并先后制定了不同的开始标准。2012-2015年,国际指南建议对所有HIV感染的成年人即时诊断即时治疗,不管其CD4~＋T淋巴细胞（简称CD4细胞）计数是多少。这一倡议面临着许多挑战,从＂CD4细胞为500个/mm3开始治疗＂转变到＂每个人都治疗＂,这不仅需要更多的检测和药物,还意味着需要更多的人去支持病人并帮助他们维持治疗,尤其是在低资源且发病严重的地区。因此,如何响应这一指南建议,在全球范围内实现普遍自愿测试和即时治疗,是今后一段时期内非常关键的问题。

＂When to start antiretroviral therapy（ART）in asymptomatic patients＂is a problem,being constantly explored in the medical field of the world.During the thirty years since introduction of ART,a number of researches has been done for the evidence to set different standards for initiation of ART.Between 2012 and 2015,international guidelines recommended to start immediate ART after diagnosis of HIV even for asymptomatic HIV-infected adults regardless of their CD4 count.However,this recommendation has been greatly challenged,as the early therapy requires more tests,drugs,and people to support and care the patients in the continuous treatment,especially in lowresource settings and the most affected region by HIV/AIDS.Therefore,it is important to know how to respond to the guidelines and promote the strategy of universal voluntary testing and immediate treatment.