某艾滋病治疗示范区三种抗人类免疫缺陷病毒治疗方案疗效比较

The comparison of the effects of three kinds of anti-retroviral therapy on patients with human immunodeficiency virus infection in acquired immune deficiency syndrome area

目的探讨某AIDS治疗示范区3种高效抗反转录病毒疗法(HAART)的疗效,为进一步合理使用抗病毒治疗方案奠定基础。方法回顾性分析AIDS治疗示范区抗病毒治疗6个月以上的3种治疗方案:叠氮胸苷(AZT)+双脱氧肌苷(DDI)+奈韦拉平(NVP),拉米夫定(3TC)+司他夫定(D4T)+NVP.D4T+DDI+NVP。分别检测HIV RNA、CD4^+细胞、耐药位点,统计学分析采用t检验或四格表法检验。结果3种治疗方案中,抗病毒治疗前后HIV RNA的转阴率比较.AZT+ DDI+NVP组与3TC+D4T+NVP组差异无统计学意义(P>0.05),D4T+DDI+NVP组与AZT +DDI+NVP组差异有统计学意义(P<0.05);3组CD4^+T淋巴细胞计数在治疗前后差异有统计学意义(P<0.05);其中AZT+DDI+NVP组CD4^+T淋巴细胞计数为(100～350)×10~6/L,HIV RNA转阴率较其他各组差异有统计学意义(P<0.05);AZT+DDI+NVP组核苷类反转录酶抑制剂(NRTIs.AZT+DDI)发生的耐药位点是M41L、E44A、K70KR、D67N、L210W、T215Y、K219W等.属于高度耐药;非核苷类反转录酶抑制剂(NNRTIs,NVP)是A98G、V179H、Y181C、K103N、G190A等,属于高度耐药;3TC+D4T+NVP组NNRTIs(NVP)发生的耐药位点是Y181C,未见3TC突变位点。DDI+D4T+NVP组NNRTIs发生的耐药位点是Y181C;但以上各组均未发现对蛋白酶抑制剂(PIs)耐药位点。结论AZT+DDI+NVP与3TC+D4T+NVP组疗效优于DDI+D4T+ NVP组,可获得较好疗效。

Objective To compare the effects of three kinds of high active anti-retroviral therapy（HAART） in acquired immune deficiency syndrome（AIDS） area and provide the basis for applying HAART better in the future. Methods The effects of three kinds of HAART [Zidovudine（AZT）＋ Dideoxyinosine（DDI） ＋ Nevirapine （ NVP）, Lamivudine （3TC） ＋ Stavudine （D4T） ＋ NVP and D4T ＋ DDI＋NVP）] in AIDS area over 6 months were analyzed retrospectively. HIV RNA, CD4^＋ T cells, the sites of drug resistance were detected. The data were analyzed using t test or 2 × 2 table test. Results Of the three kinds of HAART, there were no difference of HIV RNA negative rate between AZT＋ DDI＋ NVP group and 3TC＋ D4T＋ NVP group（P 〉 0.05 ）; however there were significant difference between D4T＋DDI＋NVP group and AZT＋DDI＋NVP group（P 〈 0.05 ） ; furthermore, the CD4^＋ cell counts were different in these three groups before and after treatment （P 〈 0.05 ） and the HIV RNA negative rate in AZT＋ DDI＋NVP group was much higher than the other groups（P 〈 0.05 ）when the CD4^ ＋ cell counts were （ 100- 350） ）× 10^6 / L. The detection of sites of drug resistance： the major mutant sites to AZT＋DDI were M41L, E44A, K70KR, D67N, L210W, T215Y or K219W which were highly resistant and to NVP were A98G, V179H, Y181C, K103N or G190A which were highly resistant in AZT＋DDI＋NVP group. Meanwhile, the site to NVP was Y181C and no sites to 3TC in 3TC＋D4T＋ NVP and DDI＋D4T＋NVP group. There were no mutant sites of drug resistance to protease inhibitors （PIs） in all the HAART groups. Conclusion It will be better choice of AZT＋DDI＋NVP or 3TC＋D4T ＋NVP group than DDI＋D4T＋NVP group for treatment in Chinese AIDS patients.