艾滋病患者抗逆转录病毒治疗的肝毒性特点分析

Hepatotoxicity associated with antiretroviral therapy containing non-nucleosides reverse transcriptase inhibitors in HIV/AIDS patients

目的分析包含非核苷类逆转录酶抑制剂联合抗逆转录病毒治疗(HAART)的肝毒性特点。方法回顾研究75例接受包含奈韦拉平或依非韦仑的联合抗逆转录病毒治疗的HIV/AIDS患者,对出现肝毒性者进行肝毒性分级,分析性别、年龄、HBV和/或HCV感染、其他肝毒性药物及NNRTIs种类对肝毒性发生的影响。结果75例接受HAART的HIV/AIDS患者中,45例(60.0%)发生至少1次肝毒性,其中肝毒性1级26例(57.8%),2级16例(35.6%),3级2例(4.4%),4级1例(2.2%);男性31例(68.9%),女性14例(31.1%),差异无统计学意义(χ2=0.658,P=0.428);肝毒性组患者平均年龄(39±9)岁,无肝毒性组平均年龄(38±12)岁,差异无统计学意义(t=73,P=0.511);合并HBV和/或HCV感染肝毒性组29例(64.4%)、无肝毒性组11例(36.7%),差异有统计学意义(χ2=5.581,P=0.018);应用基于NVP的HAART方案者肝毒性发生率为88.9%(32/36):应用基于EFV的HAART方案者肝毒性发生率为33.3%(13/39),差异有统计学意义(χ2=24.07,P=0.000);同时应用抗结核药物或复方新诺明肝毒性组30例(66.7%)、无肝毒性组12例(40%),差异有统计学意义(χ2=5.195,P=0.023)。结论包含NNRTIs的联合抗逆转录病毒治疗所致的肝毒性多为轻到中度,合并感染HBV和/或HCV、应用包含NVP的治疗方案和同时应用其他肝毒性药物的患者容易出现肝毒性,需要密切监测。

Objective To study the features of hepatotoxicity associated with antiretroviral therapy（HAART） containing non-nucleosides reverse transcriptase inhibitors. Methods 75 patients on antiretroviral therapy containing non-nucleosides reverse transcriptase inhibitor were retrospectively studied. The patients were divided into 2 groups： hepatotoxiciy group（n=45） and non-hepatotoxicity group（n=30）. The features of hepatoxicity were analyzed and compared be-tween two groups. Results 45 patients, 31（68.9%） males and 14（31.1%） females（X^2=0.658,P=0. 428）, experienced at least one episode of hepatotoxicity. Grade 1 hepatotoxicity were observed in 26 （34.7%） patients, grade 2 in 16 （21.3%）, grade 3 in 2（2.7%） and grade 4 in 1 （1.3%）. 32（88.9%） patients receiving NVP-containing regimes and 13（33.3%） patients receiving EFV-eontaining regimen experienced hepatotoxicity, respectively（X^2=24.07,P=0.000）. 29（64.4%） patients co-infected with HBV and/or HCV and 30（66.7%） had concomitant use of antibuberculosis drugs or cotrimoxazole in hepatotoxicity group, respectively, which was significantly higher compared with those in the non-hepa-totoxicitygroup （X^2=5.581, P=0.018 and X^2=5.195, P=0.023, respectively）. Conclusion Hepatotoxicity associ- ated with HAART containing non-nucleosides reverse transcriptase inhibitors was mild to moderate and those who had co- infected HBV and/or HCV, and concomitant use of antibuberculosis drugs or cotrimoxazole and those that received a regimen containing NVP were prone to hepatotoxicity while receiving HAART.