HIV/AIDS患者合并梅毒感染的治疗方案探讨和疗效分析

Efficacy analysis of antibiotic treatment for syphilis in patients co-infected with HIV/AIDS

目的了解HIV/AIDS患者伴梅毒感染在不同CD4 T淋巴细胞水平下用苄星青霉素和头孢曲松治疗后的效果和血清学变化过程。方法共104例患者分为3组,其中64例为HIV/AIDS伴梅毒感染者,根据CD4 T淋巴细胞计数的不同,分为A、B 2组,每组均为32例,CD4 T淋巴细胞计数在200 cells/μL以上为A组,200 cells/μL以下为B组。对3组患者均给予苄星青霉素治疗,根据快速血浆反应素(RPR)效价变化情况再给予头孢曲松治疗。结果 3组转阴率相比,x^2=3.810,P=0.149>0.05,结果差异无统计学意义,但从临床实际情况来看,对照组的转阴率优于A组,A组的转阴率优于B组。3组的显效率相比,x^2=10.283,P=0.006<0.01,差异有统计学意义,结合临床,提示对照组的显效率优于A组,A组的显效率优于B组。结论无论是免疫功能正常还是免疫功能异常者在相同疗程和剂量下用3周240万u苄星青霉素治疗RPR的转阴率无统计学意义,但显效率有统计学意义。转阴率的高低与CD4 T淋巴细胞计数和药物使用情况及疗程相关。HIV/AIDS患者感染梅毒螺旋体后,应该使用苄星青霉素和头孢曲松进行多个疗程的治疗。

Objective To understand the efficacy and change of rapid plasma reagin（RPR） titer after benzathine penicillin and ceftriaxone treatment of syphilis in HIV/AIDS patients with different levels of CD4 T cells.Methods The patients co-infected with HIV/AIDS and syphilis were divided into two groups based on the level of CD4 T cells.The CD4 T cell count of the patients was higher than 200 cells/μL in Group A（n=32）,lower than 200 cells/μL in Group B（n = 32）.Additional 40 HIV/ AIDS patients in the control group did not have syphilis.All the patients in these three groups were given benzathine penicillin to treat syphilis.Ceftriaxone was added if RPR titer did not improve.Results No significant difference was found between the three groups in terms of the negative seroconversion rate of RPR titer（χ~2=3.810,P = 0.149）.However,in clinical context, the negative seroconversion rate of the control group was superior to that of Group A.The negative rate of group A was superior to that of group B.The efficacy was significantly different between the three groups（χ~2=10.283,P = 0.006）.Considering the clinical context,this result suggested that the efficacy of control group was higher than Group A.The efficacy of Group A was higher than Group B.Conclusions The negative seroconversion rate of RPR did not show significant difference in the HIV/ AIDS patients after treatment with 2.4 million units of benzathine penicillin for three weeks,whether their CD4 T cell count was higher or lower than 200 cells/μL.The negative seroconversion rate was associated with CD4 T lymphocyte count and the regimen and duration of antibiotic treatment.The patients co-infected with Treponema pallidum and HIV/AIDS should actively receive long-term treatment with benzathine penicillin and ceftriaxone.