70例艾滋病患儿高效抗反转录病毒治疗的临床观察

Clinical observation of highly active antiretroviral therapy in 70 pediatric patients with acquired immunodeficiency syndrome

目的观察AIDS患儿抗病毒治疗疗效及存在的临床问题，为提高我国现行儿童AIDS规范治疗和管理水平提供依据。方法根据我国现行儿童AIDS治疗方案，为德宏州符合条件的AIDS患儿提供抗反转录病毒治疗（ART），并定期进行临床随访观察和相关实验室检测。结果截至2009年3月底，共有70例AIDS患儿进行抗病毒治疗，采用齐多夫定（AzT）＋拉米夫定（3TC）＋奈韦拉平（NVP）方案的共60例。治疗3、6、12和18个月时有12、18、23和19例患儿检测病毒载量（VL），VL≤1000拷贝／mL的分别有7、12、14和14例。CD4＋T淋巴细胞计数治疗前为（317．8±288．8）×10^6／L，18个月时回升至（1037．2±1086．1）×10^6／L。不良反应多出现于治疗的前3个月，近50％患儿有不同程度的消化道反应。对治疗12个月的5例耐药患儿检测表明，均出现对3TC、NVP和依非韦伦不同程度的耐药。结论儿童抗病毒治疗具有良好的依从性，治疗效果明显，不良反应主要发生在治疗的前3个月，以消化道反应最常见。

Objective To observe the treatment response and potential issues related to antiretroviral therapy （ART） in pediatric patients with acquired immunodeficiency syndrome （AIDS） and to provide a basis for revising the treatment guideline and improving the clinical practice. Methods Children eligible for ART according to the current treatment guideline were recruited from Dehong area. Enrolled patients were provided with ART and followed up for regular clinical check and laboratory tests. Results By the end of March 2009, a total of 70 children had received ART. Among them, 60 patients were treated with regimen including zidovudine （AZT）＋ lamivudine （3TC）＋ nevirapine （NVP）. Twelve, eighteen, twenty-three and nineteen patients have tested for HIV viral load after 3 month, 6 month, 12 month and 18 month treatment, respectively. Among them, 7, 12, 14 and 14 patients respectively achieved HIV viral load lower than 1000 copy/mL. Average CD4＋ T lymphocyte count increased from （317.8 ＋ 288.8） X 10^6/L at baseline to （ 1037.2 _＋ 1086. 1 ） X 10^6/L after 18 month treatment. Side effects mainly occurred within the first 3 months of treatment. Nearly 50%of children had gastrointestinal symptoms. Resistance to 3TC, NVP and efavirenz （EFV） were found in five patients who have completed 12 months of treatment. Conclusions Pediatric AIDS patients show good compliance and treatment response to ART. Most side effects happen in the first 3months of treatment and the most common side effects are gastrointestinal symptoms.