0.14 ( 0.053%) UNAIDS 10% (94) ( ) (73-94/6 ) 8,920

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1 0.14 UNAIDS 0.053% % /6 8,

2 Public Health Service Task Force Recommendations 5-10% for Use of Antiretroviral Drugs in 10-20% Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission 5-10% in the United States February 24, % % 15-30% 25-35% % [1] 44

3 PACTG 076 Zidovudine 100 mg mg/ 1 mg/ mg/ TC 200 mg 300 mg 100 mg mg/ mg/ 2.0 mg/ mg Pediatric AIDS Clinical Trials Group PACTG Protocol 076 [2] 2 mg/kg 1 mg/kg/ hour 3 zidovudine 70% kg/dose 2 mg/ Public Health Service USPHS 45

4 PACTG076 + lamivudine [3TC] 1994 PACTG Protocol highly active antiretroviral therapy ; HAART; 1,000 copies/ml [3] 46

5 TC 3TC 1.6% 6.8% 3 Public Health Service USPHS ,920 [4] [5] CD4 count CD4 2.6 PACTG 367 1,472 [6] 1 47

6 2005 USPHS 2. Nucleoside Reverse Transcriptase Inhibitors; NRTIs dysfunction mitochondrial DNA polymerase- DNA 1. Protease inhibitor; PIs 25 HELLP PIs NRTIs 48

7 NRTIs 1999 d4t 3TC CD4 [7] nnrtis CD Non-nucleoside Reverse Transcriptase Inhibitors;NNRTIs efavirenz 200mg 72 2 mg/kg HIVNET012 [8] Public Health Service USPHS 15-20% 2005 Efavirenz 10-15% 49

8 HIV ~80% , 000 copies/ ml 1, copies/ml 2 mg/kg 1 mg/kg/hour 1, 000 copies/ ml 50

9 HIV-1 HIV < > /ch/das/upload/download/ healtheducation/cdc/fictional/ babymother.doc.accessed 24 May Connor EM, Sperling RS, Gelber R, et al: Reduction of maternal-infant transmis- 51

10 sion of human immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med 1994;331: Mandelbrot L, Landreau-Mascaro A, Rekacewicz C, et al: Lamivudinezidovudine combination for prevention of maternal-infant transmission of HIV-1. JAMA 2001;285: Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States- February 24, default_db2.asp?id= The European Collaborative Study and the Swiss Mother + Child HIV Cohort Study. Combination antiretroviral therapy and duration of pregnancy. AIDS 2000;14: R. Tuomala, July 2000 PACTG meeting. 7. Luzzati R, Del Bravo P, Di Perri G, et al: Riboflavine and severe lactic acidosis. Lancet 1999;353: Guay LA, Musoke P, Fleming T, et al: Intrapartum and neonatal single-dose compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet 1999;354:

11 FDA Nucleoside reverse transcriptase inhibitors; NRTIs Abacavir C Ziagen, ABC 1000 mg/kg [ 35 ] Didanosine B Videx, ddi [0.5] Emtricitabine B Emtriva, FTC Lamivudine C Epivir, 3TC [~1.0] Stavudine C Zerit, d4t [0.76] Tenofovir DF B Viread Zalcitabine C HIVID, ddc [ ] 53

12 Zidovudine+ C Retrovir, AZT, [0.85] Non-nucleoside reverse transcriptase inhibitors; NNRTIs Delavirdine C Rescriptor Efavirenz D Sustiva [~1.0] / Nevirapine C Viramune [~1.0] Protease inhibitors PI Amprenavir C Agenerase Atazanavir B Fosamprenavir C Lexiva amprenavir fosamprenavir 54

13 Indinavir C Crixivan Lopinavir/ C Ritonavir Kaletra Nelfinavir B Viracept Ritonavir B Norvir Saquinavir B Fortovase Fusion inhibitors Enfuvirtide B Fuzeon FDA A: B: C: D: X: 55

14 HIV NRTIs NRTIs mitochondrial toxicity NRTIs NNRTI NRTIs PIs NRTIs HIV Zidovudine zidovudine stavudine Lamivudine zidovudine lamivudine zidovudine NRTI Didanosine didanosine stavudine NRTI didanosine stavudine Emtricitabine NRTI Stavudine NRTI didanosine stavudine stavudine didanosine zidovudine 56

15 Abacavir 5-8% rechallenge Tenofovir tenofovir Zalcitabine 57

16 1 HIV NNRTIs Nevirapine CD4 + CD4 + > 250/mm 3 CD4 + > 250/mm 3 CD4 + Efavirenz FDA D efavirenz efavirenz % 3 PI Protease Inhibi- 58

17 tors PIs Nelfinavir nelfinavir 1250 mg nelfinavir Nelfinavir 750 mg HAART nelfinavir nelfinavir lopinavir/ritonavir efavirenz atazanavir Saquinavir-soft gel capsule [SQV- SQV 800 ritonavir SGC] Fortovase / mg ritonavir saquinavir-sgc ritonavir 100 mg mg saquinavir-sgc 1200 SQV SQV1,000 59

18 ritonavir 100 mg SQV [HGC ]/ ritonavir 2 HIV Alternate agents Indinavir 18 nelfinavir SQV/ ritonavir PI hyperbilirubinemia indinavir ritonavir indinavir 800 mg indinavir/ritonavir HIV RNA indinavir Lopinavir/ ritonavir lopinavir 400 mg 60

19 ritonavir 100 mg HIV Ritonavir PI ritonavir PI Amprenavir propylene glycol Fosamprenavir Atazanavir hyperbilirubinemia Fusion Inhibitors Enfuvirtide 61

20 Zidovudine lamivudine Combivir Zidovudine lamivudine abacavir Trizivir PI HAART NRTI abacavir HIV NNRTI PI HAART NRTI HIV RNA<55,000 copies/ml zidovudine/lamivudine/abacavir class-sparing regimen HIV-1 1. HIV-1 2. HIV-1 HIV RNA 3. HIV-1 RNA 1,000 copies/ml HIV-1 HIV-1 RNA < 1,000 copies/ml HIV-1 1. HIV-1 2. HIV

21 HIV TC 1-3TC CD4+ HIV-1 RNA TC+NVP 4. CD4+ HIV-1 RNA HIV 63

22 6 2 mg/kg 2 mg/kg 10% 6 1 mg/ 27% 6 kg/ 62% 95% % /3TC TC mg mg/kg 9% % mg 3TC 2mg/ 42% kg 7 3TC 150 mg mg Nevirapine mg 12% 2 mg/kg 21% 47% 6 19% 64

23 95% * 20~ 64% 46% Z D V - 6 Nevirapine 2 2 mg/kg mg/kg mg/kg/ HIV 200 mg 2 mg/kg % mg/kg 2.0 mg/ kg mg/kg

24 HIV-1 1. HIV-1 2. CD4 HIV-1 RNA <1,000 copies/ml zidovudine +3TC HIV-1 3. HIV-1 HIV-1 4. PACTG HIV

25 HIV-1 : 36 HIV-1 HIV-1 HIV-1 RNA 1. PACTG : HIV-1 36 HIV-1 RNA 1,000 copies/ml 1.HIV-1 RNA HIV-1 RNA 1,000 copies/ml HIV HIV-1 36 HIV-1 RNA 1. HIV-1 RNA HIV-1 2% 2. 67

26 : HIV

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