运城市MSM AIDS病人免费抗病毒治疗的疗效分析

Effect analysis of free antiretroviral treatment among MSM with AIDS in Yuncheng

目的探讨运城市男男性行为人群（MSM）艾滋病（AIDS）病人抗病毒治疗的效果,为进一步开展有效的抗病毒治疗提供依据。方法收集2010年1月至2013年6月运城市,MSM艾滋病病人抗病毒治疗的相关资料,分析病人的基本情况、治疗方案、治疗前后CD＋4T淋巴细胞计数、病毒载量、机会性感染、不良反应、终止治疗及耐药状况。结果 55例MSM AIDS病人,年龄22-54岁,未婚占36.36%（20/55）,已婚或同居占56.36%（31/55）,离异或分居占7.27%（4/55）;有肛交史的100%（55/55）,有口交史的69.09%（38/55）,有多性伴的96.36%（53/55）,有固定性伴的3.64%（2/55）。在抗病毒治疗1/2年、1年、2年、3年,CD＋4T淋巴细胞中位数由238/μL、224/μL、222/μL、75/μL增至292/μL、339/μL、423/μL、211/μL;抗病毒治疗3-36个月（平均13.81个月）,88.89%（32/36）的病人病毒载量〈40拷贝/mL;有机会性感染的AIDS病人数,由治疗前的40.00%（22/55）下降到抗病毒治疗6个月内的14.55%（8/55）;43.64%（24/55）的病人出现不良反应;80.00%（44/55）的病人依从性≥95%;自行停药3.64%（2/55）,死亡9.09%（5/55）,失访3.64%（2/55）,耐药16.67%（1/6）。结论运城市MSM AIDS病人存在特殊的性行为、多性伴等高危行为,服药依从性较好,抗病毒治疗效果显著。

Objective To explore the efficacy of antiretroviral treatment（ART） in men who have sex with men （MSM） with AIDS and provide scientific basis for further effective therapy. Methods Informations on ART was collected in MSM with AIDS in Yuncheng from January 2010 to June 2013. Statistical analyses included the basic information of patients, treatment regimes, CD4＋ T cell counts before and after treatment, viral load, clinical symp toms and signs, termination of treatment and changes of living conditions. Results There were 55 patients, with age ranged from 22 to 54 years old. The unmarried accounted for 36.36%（20/55）, married or cohabiting 56.36% （31/55）, divorced or separated 7.27Y0 （4/55） ,anal sex 100%（55/55）, oral sex 69.09%（38/55）, multiple sex partners 96.36%（53/55）, and regular sexual partners 3.64% （2/55）. After 6 months, 1 year, 2 years and 3years of ART, the median of CD4＋T lymphocyte cell counts increased from 238, 224, 222, 75 to 292, 339, 423 and 211 cells/μL, respectively. Duration of ART was 3 to 36 months （average 13.81 months）. Patients with viral load 40 copies/mL were 88.89% （32/36） after ART. The incidence of opportunistic infections decreased from 40.00% （22/55） before treatment to 14.55% （8/55） at the end of 6 months of ART. Drug adverse reactions appeared in 43.64% （24/55） of patients. The patients with good adherence （≥95%） accounted for 80.00% （44/55）, with drawal cases 3.64% （2/55）, death cases 9.09%（5/55）, lost cases 3.64%（2/55）, and drug-resistant cases 16.67% （1/6）. Conclusion MSM patients have high risk behaviors such as special sexual behaviors and multiple sexual partners. Their adherence is good. ART effect is remarkable in MSM patients.