300例艾滋病患者高效抗逆转录病毒治疗后免疫重建规律探讨

The study of immunologic reconstitution in HIV/AIDS highly active antiretroviral therapy

目的探讨高效抗逆转录病毒治疗（HAART）对中国南部地区艾滋病患者的免疫重建规律。方法收集近3年来300例患者的完整资料，按基线CD4^＋T细胞数分为A、B、C三组，观察基线及治疗1、3、6、12月末CD4^＋T淋巴细胞数、12月末血浆病毒载量（VL）、临床症状和毒副作用。结果抗病毒治疗12月末300例患者CD4^＋T淋巴细胞计数平均上升127个／1，以治疗3月后增长明显，3、12月末与基线CD4^＋T淋巴细胞计数比较差异有显著性（P〈0．05）；12月末273例（91％）患者血浆病毒载量（VL）〈5copies/ml，27例（9％）患者病毒载量（VL）〉50copies/ml，高病毒载量A组16例，C组4例；A组与C组比较差异有显著性（P〈0．05）；药物不良反应主要是外周神经炎（35．4％）、骨髓抑制（18．2％）、皮疹（15．2％）、肝功能损害（12．1％）、乳酸酸中毒（12．1％）和肾结石（6．1％）。结论HAART治疗对中国南部地区的艾滋病患者有效，能够实现免疫重建，但存在较多毒副作用。

Objective To observe the immunologic reconstitution in HIV/AIDS patients from the area of south China with highly active antiretroviral therapy（HAART）. Methods 300 HIV/AIDS patients in recent three years were divided in to A, B, C three groups randomly according to baseline CD4^＋T cell counts. The counts of CD4^＋T cell were observed in patients at baseline and after 1,3,6 and 12 months of HAART, respectively, and plasma viral load （VL） was detected at the end 12 months, Clinical symptoms and drug side-effects were also observed. Results The counts of CD4^＋T were raised 127 cell/1 in these 300 HIV/AIDS patients after 12 months with HAART. The rise in CD4^＋ T cells was significant after HAART 3 months with. A significant increase in CD4^＋T cells was observed at 3 and 12 month after HAART compare to the baseline CD4^＋T cells counts （t = 16. 8,t = 11.95 ,P 〈0.05）. After 12 months of treatment,plasma viral load was less than 50 copies/ml in 273 （91%） HIV/AIDS patients while viral load more than 50 copies/ml found in 27 cases. These were 16 cases with high viral load in group A and 4 cases in group C, Difference of the two groups was significant（ Х^2 =4.37 P 〈0.05 ）. The main side-effects in HAART were neuropathy （ 35.4% ）, bone marrow depression（ 18.2% ）, rash（ 15.2% ）, liver function injury（ 12.1% ）,lactic acidosis （12. 1% ） and kidney calculi （6. 1% ）. Conclusion Highly active antiretroviral therapy was effective in HIV/AIDS patients in the area of south China, and immunologic reconstitution achieved by highly active antiretroviral therapy with some side-effects observed.