含克力芝组合的HAART方案对HIV/HCV混合感染的疗效探讨

A study on the efficacy of LPV/r(Kaletra)-based HAART regimen for patients with HIV/HCV co-infection

目的探讨含克力芝(LPV/r)组合的高效抗反转录病毒治疗(HAART)方案,对艾滋病病毒(HIV)、丙型肝炎病毒(HCV)混合感染治疗的效果。方法采用前瞻性研究方法,选择HIV/HCV混合感染患者43例,通过Spw-Pb网络数据平台随机分为研究组与对照组。研究组22例,采用以洛匹那韦/利托那韦(LPV/r)为基础的HAART治疗方案;对照组21例,采用以依非韦伦(EFV)为基础的HAART治疗方案。研究组与对照组检测基线CD4+T淋巴细胞计数、HIV病毒载量、丙氨酸转氨酶(ALT)、胆固醇(CHO)、甘油三酯(TG)等指标;治疗后48周分别检测上述指标,研究终点为48周。观察病毒学、免疫学、ALT、CHO、TG等指标的变化。结果 HAART治疗48周,研究组与对照组HIV-RNA阴转率比较差异无统计学意义(P>0.05)。研究组与对照组基线CD4+T淋巴细胞、ALT、CHO、TG比较差异无统计学意义(均P>0.05);HAART治疗48周,研究组CD4+T淋巴细胞计数增长明显高于对照组,差异有统计学意义(P<0.05);而研究组与对照组ALT、CHO、TG比较差异无统计学意义(均P>0.05)。结论含LPV/r组合的抗病毒方案对HIV/HCV混合感染治疗效果较优越,CD4+T淋巴细胞增长较明显,胆固醇、甘油三酯变化不大,建议HIV/HCV混合感染HAART治疗选择LPV/r方案为佳。

Objective To investigate the efficacy of LPV/r based highly active antiretroviral therapy（HAART） regimen in patients with Human Immunodeficiency Virus（HIV） and Hepatitis C Virus（HCV） co-infection.Methods Forty three HIV/HCV co-infected patients were included in a prospective study,who were randomly classified into research and control groups by the Spw-Pb web data platform.The 22 patients in the research group and the 21 patients in the control group were treated using lopinavir/ritonavir（LPV/r）-based and efavirenz（EFV）-based HAART,respectively.Baseline CD4＋ T lymphocyte counts,HIV loads,glutamate alanine aminotransferase（ALT） levels,cholesterol（CHO） levels and triglyceride（TG） levels were measured for both the groups.These measures were examined again after 48 weeks of treatment,which was used as the endpoint of the study.Changes were thus observed in various aspects of virology,immunology,ALT,CHO and TG.Results After 48 weeks of HAART,there was no statistically significant difference in the HIV clearance rate between the research and control groups（P0.05）.As for baseline CD4＋ T lymphocyte counts,ALT,CHO or TG levels,no statistically significant differences were observed between the two groups either（P0.05 in all the comparisons）.After 48 weeks of HAART,the CD4＋ T lymphocyte count increased greater in the research group than in the control group,and the difference was found to be statistically significant（P0.05）.On the other hand,the differences in ALT,CHO and TG level changes before and after 48 weeks of HAART were not statistically significant between the research and the control groups（P0.05 in all the comparisons）.Conclusions The LPV/r based HAART regimen is superior to the EFV based regimen for patients with HIV/HCV co-infection,primarily due to its greater increase in CD4＋ T lymphocyte counts and similar CHO/TG effects.Therefore,this regimen is recommended to be used for patients with HIV/HCV co-infection.