強效抗反轉錄病毒療法（highly active anti-retroviral therapy；HAART）是目前治療後天 性免疫缺乏症候群(acquired immunodeficiency syndrome，AIDS)最常用的方式，由於必須結 合多種藥品，也就是俗稱的雞尾酒療法，故在治療上常見的問題包括藥品引起的不良反應， 以及藥品交互作用等，增加治療時的困難度及複雜性，本案例係報導一位 65 歲男性病患因 診斷出為後天免疫功能不全症候群且併發伺機性肺結核感染，給予強效抗反轉錄病毒療法 後相繼發生了疑似 efavirenz 導致全身紅疹情況及疑似 zidovudine 引起的骨髓抑制，故將 efavirenz 、 zidovudine 分 別 改為 lopinavir 133.3 mg + ritonavir 33.3 mg （ Kaletra ） 及 didanosine，症狀隨即獲得改善，另外，由於本案例亦合併肺結核感染，必須接受抗結核病 藥品治療，也因為 Kaletra與抗結核病藥品產生交互作用，故將 rifampin 劑量由原先每日 600 mg 調降到每日 300 mg，而 Kaletra則從每日 6 顆，調升至每日最大建議劑量 8 顆，也 將 isoniazid 與 pyrazinamide 的劑量分別調降至 5 mg/kg 與 15 mg/kg，結果顯示這樣的調整 方式是合適的。
Highly active anti-retroviral therapy (HAART) is the most common way of combating HIV and AIDS. HAART itself combines many kinds of drugs like its popular name “cocktail therapy”. Therefore, there are many problems when treating patients with drug-induced adverse reactions and drug-drug interactions, which increase difficulty and complexity of the therapy. This case reported a 65-year-old man who was diagnosed with acquired immunodeficiency syndrome with opportunistic infection of Mycobacterium tuberculosis. After receiving highly active anti-retroviral therapy, including efavirenz and zidovudine, skin rash spread over the whole body and leukopenia was also noted. Efavirenz and zidovudine were strongly suspected as the main causes of the adverse reactions. After efavirenz and zidovudine were change to Kaletra and didanosine, the patient’s symptoms improved. In addition, this patient also took anti-tuberculosis agents. The drug dosage needed adjusting due to the drug-drug interactions between Kaletra and anti-tuberculosis agents. The dose of rifampin was adjusted from 600 mg to 300 mg daily and Kaletra from six tablets to eight tablets daily, the isoniazid and pyrazinamide to 5 mg/kg and 15 mg/kg, respectively. Clinical conditions followed in two months seemed to prove the adjustment appropriate.
