抗逆转录病毒治疗艾滋病41例

Treatment of 41 Cases of AIDS with Antiretrovirals

目的观察两种核苷类联合一种非核苷类逆转录酶抑制药治疗艾滋病的疗效。方法定期随访接受治疗的患者41例,观察患者症状的改善情况,测定CD4+淋巴细胞计数及病毒载量(VL),并严密监测药物不良反应,及时采取应对措施。对治疗效果不佳的患者进行基因型耐药分析。结果41例患者,治疗期间未出现死亡病例;机会性感染发生率由治疗前的56.1%降至治疗后的9.8%;随着CD4+淋巴细胞计数及CD4+百分比逐渐上升,病毒载量降至检测限以下;4例CD4+淋巴细胞计数上升一段时间后又逐渐下降,且病毒载量升至检测限以上,并出现机会性感染,2例经基因型耐药分析证实出现获得性免疫缺陷病毒(H IV)耐药。用药后出现轻中度皮疹4例,全身性皮疹2例;外周神经炎9例;肝功能轻度异常7例;严重贫血1例,换药及皮下注射促红细胞生成素后好转。结论国家免费提供的抗病毒药物治疗艾滋病,可取得良好疗效。对出现严重不良反应的患者,应及时调整其治疗方案;对出现非严重不良反应的患者,应鼓励其坚持治疗,并对症处理。耐药株的出现使艾滋病的防治工作面临新的挑战。但能够降低病死率,延长患者生命。

Objective To survey the therapeutic effectiveness of two nucleoside-inhibitors plus one non-nucleoside-inhibitor of reverse transcriptase in the treatment of patients with acquired immuro deficiency syndrome(AIDS). Methods 41 patients with AIDS were subjected to the medication carried out strictly according to the directions.The course of treatment lasted 21.2 months in adults and 16.6 months in children.The patients were followed up at regular intervals.Improvement in symptoms was kept under observation.CD_4^+ lymphocyte counts and viral load(VL) were measured.Adverse drug reactions were closely monitored and corresponding measures were taken if any of these reactions were encountered.For those patients with unsatisfactory curative effects,drug resistance analyses at the genome level were carried out. Results During the course of treatment,none of the patients died.The incidence of opportunistic infections dropped from 56.1% before the treatment to 9.8% after the treatment.The viral load was decreased to below the detection level along with the increase in the counts and percentages of CD_4^+ lymphocytes.In 4 patients the CD_4^+ counts were shown to decrease again after an increase in a period of time and the viral load rose to levels above the detection limit.In the mean time they suffered opportunistic infections.Besides,the HIV in 2 patients was demonstrated to have acquired drug resistance as revealed by the drug resistance analysis at the genome level.The adverse reactions encountered were: 4 cases of skin rash from mild to moderate degree,2 cases of generalized eruption,9 cases of peripheral neuritis,7 cases of abnormal liver function and 1 case of severe anemia that responded well to the treatment with recombinant human erythropoietin(rHuEPO). Conclusion The antivirals provided free of charge by the State was shown to be fairly effective in the treatment of patients with AIDS.The treatment plan should be timely readjusted in patients manifesting severe adverse reactions.Patients with not very severe adverse reactions should be encouraged to insist on further treatment associated with symptomatic managements.The prophylaxis and treatment of AIDS have to face new challenges owing to the appearance of drug resistant HIV variants.