Dose reduction of antiretrovirals: a feasible and testable approach to expand HIV treatment in developing countries

Il est très improbable que les systèmes de santé dans les pays en développement soient toujours en mesure d'inscrire de nouveaux patients et de maintenir les patients sous traitement antirétroviral dans le long terme. Cela à cause de la crise économique mondiale, les orientations des bailleurs de fonds en fonction des priorités pour la santé mondiale et les changements dans les nouvelles recommandations de l’OMS pour commencer les antirétroviraux à un seuil de 350 cellules CD4/mm3, qui influeront tous sur la disponibilité de l'aide pour la thérapie antirétrovirale. Nous proposons d'explorer de toute urgence la réduction de la dose des différents antirétroviraux comme une des options possibles pour aider et maintenir le traitement antirétrovirale dans les pays en développement. Des doses plus faibles de stavudine, éfavirenz, atazanavir, darunavir, lopinavir/ritonavir, ténofovir sont à l’étude ou sont à explorer et pourraient réduire les coûts et permettre un accès plus étendu à la thérapie anti‐VIH pour les populations dans le besoin. La réduction de la dose pourrait également diminuer les effets indésirables, améliorer la tolérance et l'observance du traitement sans compromettre l'efficacité. Il est urgent de mettre en œuvre des essais de non‐infériorité assez larges, bien suivis, comparant des doses plus faibles d'antirétroviraux à celles actuellement utilisées.

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