艾滋病感染者抗病毒治疗的服药依从性及其相关因素的研究

Study on adherence and interrelated factors of acquired immunedeficiency syndrome patients receiving antiretroviral treatment

目的了解河南省艾滋病病毒感染者/艾滋病患者(HIV/AIDS)高效联合抗病毒疗法(HAART)的服药依从性及其相关因素.方法抽取了2个AIDS综合防治示范区、1个AIDS高发县.未服药和服药在2-12个月的HIV感染者作为被调查对象,分别对服药依从性、不良反应及临床表现,治疗前后临床症状改善状况及治疗保障措施等项目,通过访谈问卷调查;同时抽取静脉血,测定评价服药者CD+4 T淋巴细胞,病毒载量,用逆转录聚合酶链反应(RT-PCR)方法扩增HIV-1 POL区基因,进行基因型耐药性分析.结果治疗组治疗时间在4-8个月的人数最多占78.24%,服药依从性达到90%～100%的占67.51%,停服和漏服药物的主要原因是不良反应占66.95%,最显著的不良反应是服药后引起的恶心、呕吐、皮疹等不适.治疗组坚持服药症状明显改善的占87.57%,停服和漏服药症状未明显改善的占11.01%.服药依从性对病情趋势变化具有显著影响(P＜0.05).治疗组服药后CD+4T细胞总数保持稳定或有所增加,但实际速度较缓慢.抗病毒治疗3个月和6个月时,患者的病情好转率分别是55.1%和50.8%,CD+4T细胞数较未服药治疗的患者显著提高.耐药性毒株的流行率显著增加,由未服药人群的13.9%快速上升到服药3个月的45.4%和服药6个月的62.7%,其中对非核苷类逆转录酶抑制剂(NNRTI)类药物耐药性的增加最为明显,导致中高度以上耐药率的显著增加.结论采取有效的抗病毒治疗以后,HIV/AIDS患者在接受抗病毒治疗过程中,服药依从性直接关系治疗效果以及对治疗计划的实施.避免耐药毒株的出现,必须提高服药依从性,这对今后评价治疗效果具有重要意义.

Objective To study on the compliance antiretroviral(ARV) drugs and interrelated factors of HIV/AIDS patients undertaking highly active antiretroviral therapy(HAART) to improve clinical treatment. Methods 3 counties in Henan province were selected including 2 counties from China Cares Program points and one county where HIV/AIDS was serious. All cases studied had already received antiretroviral therapy(ART) for 2-12 months. Several indicators through questionnaire were studied including drug adherence, side effect, symptoms status before and after treatment and ART measures etc. At the same time, blood was collected to analyze CD +_4 T-lymphocyte, the virus loads of HIV and drug genotype resistance by reverse transcription-polymerase chain reaction(RT-PCR). Results In the therapy group, most patients had taken ARV drugs for 4-8 months, which accounted for 78.24 % of the total number, with the adherence rate above 90% as 67.51 %. The main reason for the patients not listening to their doctor's advice was due to ART drug's side effects( 66.95 %), including queasiness, vomiting and tetter. In the therapy group, 82.57 % of patients' symptoms were obvious. Adherence had a great impact on the improvement( P < 0.05 ). After therapy, the total count of patients' CD +_4 T-lymphocyte's kept stable or improved with slow speed. At the time of 3 months and 6 months after ART, the rates of improvement were 55.1 % and 50.8 %. However CD +_4 count did not show much difference between the twe group. The prevalence rate of HIV drug resistance strain roise from 13.9 % in non-remedial group to 45.4 % at the time of 3 months after therapy and 62.7 % atthetime of 6 months after therapy. The resistance against non-nucleoside reverse transcriptase inhibitors (NNRTI) had improved obviously.Conclusion Patients with HIV/AIDS receiving HAART, compliance seemed directly affect the curative effect and the implementation of therapy schedule and should be improved to avoid drug resistance.