蛋白酶抑制剂对免疫重建不良艾滋病患者的免疫学影响

The immunological response after switching to protease inhibitor based regimen among suboptimal immunologic responders

目的对接受抗病毒治疗后病毒学治疗成功但免疫重建不良的患者,采用包含蛋白酶抑制剂的方案替代其原有的包含非核苷类逆转录酶抑制剂的方案,观察更换药物后患者是否发生免疫学改善。方法采用观察性临床队列研究方法,对患者更换治疗方案前后各1年的CD4+T淋巴细胞计数进行观察。结果入选的29例患者接受一线抗病毒治疗时间平均为28个月,更换为新的抗病毒治疗方案时患者CD4+T淋巴细胞计数为118个/μl,连续两次检测病毒载量<50拷贝/ml。更换药物治疗1年后,在其病毒血症被完全抑制的情况下,CD4+T淋巴细胞计数增至195个/μl。结论对病毒血症被完全抑制的免疫重建不良患者,将其非核苷类逆转录酶抑制剂方案更换为包含蛋白酶抑制剂的方案,可以明显改善患者免疫学状况。

Objective To determine if switching from initial NNRTI-based regimen to PI-containing regimen improves the immunological effect in suboptimal immunologic responders with viral load suppression. Methods An observational clinical study was performed to identify the potential immunologic effects. The change of CD4＋ T cell absolute count was detected 12 months after switching to PI-containing regimen. Results Total of 29 participants were enrolled in this study. The mean duration for first line treatment was 28 months. At the time of switching, baseline CD4＋ T count of was 118 cells/μl in these patients with two recent consecutive plasma HIV RNA less than 50 copies/ml. One year after switching to PI-containing regimen, the CD4＋ T count was 195 cells/μl with sustained undetectable viral load. Conclusions Switching from NNRTI backbone regimen to PI-based regimen could improve CD4＋ T count in suboptimal immunologic responders with viral suppression.