抗反转录病毒治疗儿童艾滋病效果评价

Evaluation of therapeutic effects of antiretrovirai therapy on pediatric acquired immune deficiency syndrome

目的 评估抗反转录病毒疗法（ART）治疗儿童AIDS的效果.方法 选择2004年3月至2008年12月符合世界卫生组织规定的治疗条件的22例HIV感染儿童进行ART,治疗方案为2种核苷类反转录酶抑制剂（NRTI）和1种非核苷类反转录酶抑制剂（NNRTI）的联合应用.治疗前、治疗后1～36个月定期检测身高、体质量、血常规、外周血CD4＋T淋巴细胞数量、CD8＋T淋巴细胞数量和血浆病毒载量（VL）,并对两组数据进行t检验.结果 19例获得临床进步,治疗后6个月身高增加倍数为1.04±0.02（t=2.356,P＜0.05）,体质量增加倍数为1.14±0.01（t=2.567,P＜0.05）,机会性感染率下降（72.7%比27.3%）;3例临床治疗失败,其身高、体质量增加迟缓,甚至下降,其中2例死亡.19例获临床进步的儿童中,VL在治疗后3个月均降至2.7 lg拷贝/mL以下;CD4^＋T淋巴细胞数从（145.50±86.72）×10^6/L升至治疗后3个月（262.80± 213.62）×10^6/L（t=2.668,P＜0.05）;CD4^＋/CD8^＋T淋巴细胞比值为0.14±0.11比0.23±0.21（t=2.607,P＜0.05）,其中CD4^＋/CD8^＋T淋巴细胞比值在治疗后9个月上升至峰值,而CD4^＋T淋巴细胞数绝对值在12个月达到峰值,随后至36个月均维持在较高水平;外周血WBC和RBC总数均下降,Hb从（107.29±13.74）g/L升至（112.15±11.20）g/L（t=2.325,P＜0.05）.结论 现阶段在我国试点开展的ART治疗方案能够抑制儿童AIDS体内病毒复制,是机体免疫重建和临床症状改善的有效方案.

Objective To evaluate the therapeutic effects of antiretroviral therapy（ART）on human immunedeficiency virus （HIV）-1-infected children. Methods Twenty-two HIV-1-infected children who met World Health Organization （WHO） criteria for treatment received ART and were prospectively enrolled in this study. ART contained two kinds of nucleoside reverse transcriptase inhibitor （NRTI） combined with one kind of non-nucleoside reverse transcriptase inhibitor （NNRTI）.Before ART and 1-36 months after ART, height, body weight, blood routine, peripheral CD4＋ and CD8＋ T cell counts and plasma viral load were followed up regularly. Comparison between groups was done by test. Results Among the 22 pediatric AIDS patients, 19 cases （86.4%） achieved clinical improve, whose height and body weight increased significantly 6 months after ART （height = 1 ：1.04±0. 02, t=2. 356, P〈0. 05; body weight= 1： 1. 14±0. 01,t=2. 567,P〈 0. 05） and opportunistic infection rate decreased （72.7 % vs. 27.3 %） ; 3 patients （13.6 % ） deteriorated, whose height and body weight increased slowly and even decreased, 2 of them died. In the 19 improved patients, viral load declined to 〈2.7 lg copy/mL at month 3 of ART, CD4＋ T cell counts and CD4^＋/CD8^＋ ratio significantly increased at month 3 of ART （CD4^＋ T cell counts： 145.50±86.72 vs. 262.80±213.62,t=2. 668, P〈0.05; CD4^＋/CD8^＋ ratio： 0. 14±0. 11 vs. 0.23±0. 21,t=2. 607, P〈0. 05） and CD4^＋/CD8^＋ ratio peaked at month 9 and absolute number of CD4＋ T cell counts peaked at month 12 and maintained at high level until month 36, peripheral white blood cells （WBC） and red blood cells （RBC） both decreased, while hemoglobin （Hb） contents increased significantly （107.29 ± 13.74 vs. 112. 15±11.20,t=2. 325,P〈0. 05）. Conclusion ART is an effective strategy for inhibition of HIV-1 replication,reconstruction of immune responses and improvement of clinical symptoms in AIDS children.