去羟肌苷、司他夫定联合奈韦拉平治疗艾滋病患者临床观察

Didanosine, Stavudine and Nevirapine in 20 cases of AIDS patients

目的观察2核苷类逆转录酶抑制剂(NRTI)联合1非核苷类逆转录酶抑制剂(NNR-TI)抗逆转录病毒方法治疗艾滋病的效果和不良反应。方法用去羟肌苷(ddI)、司他夫定(d4T)联合奈韦拉平(NVP)治疗20例HIV-1感染者和艾滋病患者(HIV/AIDS),将其分为A组(进口药)、B组(国产药)并进行为期1年的观察。随访指标为病毒载量、T淋巴细胞计数和不良反应。结果治疗1年,A组中2例因严重不良反应而终止。治疗1个月后两组的血浆病毒载量平均值明显下降,A组比治疗前下降2.12lg拷贝/ml,B组比治疗前下降2.55lg拷贝/ml。A、B两组分别在4.3个月和2个月时,均检测不到病毒载量。CD4细胞计数和CD4/CD8比例逐渐升高,由治疗前A组(231.50±156.02)/mm3、0.25±0.21,B组(49.60±45.41)/mm3、0.07±0.05,上升至治疗后A组(423.70±225.79)/mm3、0.46±0.31,B组(186.00±92.47)/mm3、0.20±0.11。两组比较,治疗前后的血浆HIVRNA降幅、CD4细胞计数和CD4/CD8比例增幅无统计学意义。治疗前CD4>200/mm3者,治疗后CD4细胞计数和CD4/CD8比例升高的绝对值明显高于CD4<200/mm3者。治疗初期不良反应有胃肠道反应、中枢神经系统症状和皮疹,不需治疗可自行缓解,严重的不良反应是周围神经病变。结论该药物组合能够很快地使病毒载量水平明显降低,同时也能够使大多数患者的免疫功能得以重建。严重的不良反应表现有周围神经病变。

Objective To observe the safety and efficacy of the anti retroviral therapy with 2NRTI and 1NNRTI. Methods Twenty cases of HIV1 infectors and AIDS patients were treated with Didanosine, Stavudine and Nevirapine. All patients were divided into two groups （group A treated by imported drugs, group B by domestically made drugs） and accepted the treatment for one year. Follow-up index included viral load, T lymphocyte count and adverse reactions. Results There were 2 cases in group A dropped out for serious adverse reaction during 1 year＇s treatment. Mean plasma viral load of both groups decreased remarkably after 1 month＇s treatment. Group A declined 2.12 lg copies/ml and group B declined 2. 55 lg copies/ml after treatment. The plasma viral load of all patients decreased to undeteetable level after treatment. It took about 4.3 months （mean time） for group A and 2.0 months （mean time） for group B respectively. The CD4 counts and the CD4/CD8 rates increased gradually. The counts of group A increased from （281.50 ± 156.02）/mm^3 , 0.25 ± 0. 21 to （428.70 ± 225.79）/mm^3 , 0.46 ± 0. 31, and the counts of group B increased from （49.60 ± 45.41）/mm^3 , 0.07±0.05 to （186.00 ± 92.47）/mm^3 , 0.20 ± 0.11. There was no statistic significance of two groups while comparing the decreased plasma HIV RNA, increased CD4 counts and CD4/CD8 rates. The increased absolute value of CD4 counts and CD4/CD8 rates of the patients whose CD4 counts were more than 200/mm^3 before treatment was remarkably higher than that of the patients whose CD4 cells were less than 200/mm^3 before treatment. Adverse reactions included gastrointestinal reactions during initial period of treatment, symptoms of central nervous system and rashes. Most of them did not need treatment and disappeared within one month gradually. The most serious adverse reaction was peripheral neuropathy. Conclusions The treatment with Didanosine, Stavudine and Nevirapine could decrease viral load remarkably and rapidly, and reestablish immunologic function of most patients simultaneously. Among adverse reactions, peripheral neuropathy was most serious.