不同CD4^＋细胞水平HIV感染者抗病毒治疗的疗效及药物不良反应分析

Efficacy and side effects of HAART in HIV-infected patients with different CD4 cell counts

目的探讨不同CD4^＋细胞水平HIV感染者抗病毒治疗的疗效及药物不良反应。方法回顾性分析广东省江门地区接受TDF（替诺福韦酯）＋3TC（拉米夫定）＋EFV（依非韦伦）方案抗HIV治疗患者的资料，根据患者CD4^＋细胞水平不同分为A组（350／txl≤CD4^＋〈500／μl），B组（200／μl≤CD4‘〈350／μl），C组（CD4^＋〈200／μ1），对比各组患者的治疗效果及药物不良反应。结果共收集临床病例132份。其中A组32例，B组42例，C组58例。三组患者在性别构成、年龄以及传播途径上差异无统计学意义（P〉0．05）。A／B／C三组患者CD4^＋细胞水平均较治疗前明显升高（P〈0．05），但治疗后6个月上升数值（75．6±52．1；80．5±58．7；97．5±78．7）及治疗后12个月上升数值（71．4±58．9；110．8±71．6；113．7±88．3）三组间比较差异无统计学意义（P〉0．05）。临床不良反应发生率3个月内C组（32／58）〉B组（14／42）〉A组（4／32），3～12个月时C组（22／58）〉B组（8／42）〉A组（1／32），三组间差异有统计学意义（P〈0．05）。结论抗病毒治疗在各个时期启动均有效果，早期启动抗病毒治疗有利于减少药物的不良反应发生率。

Objective To explore the efficacy and side effects of highly active antiretroviral therapy （HAART） in human immtinodeficiency virus （HIV）-infected patients with different CD4^＋ cell counts. Methods The clinical data of HIV-infected patients who accepted TDF （tenofovir disoproxil fumarate） ＋ 3TC （lamivudine） ＋ EFV （efavirenz） treatment were retrospectively collected in Jiangmen region. All patients were divided into group A（350/μl ≤CD4^＋ 〈 500/μl）,group B （200/μl≤CD4^＋ 〈 350/μl） and group C（ CD4^＋〈 200/μl）aecording to their CD4^＋ cell counts. The efficacy and side effects in different groups were compared. Results A total of 132 clinical cases was collected, including 32 cases in group A, 42 cases in group B, and 58 cases in group C. No statistically difference was found among three groups in terms of gender, age, or route of transmission. CD4^＋ cell counts after treatment was significantly higher than that before treatment in each group （ P 〈 0. 05 ）. The increase of CD4^＋ cell counts in groups A, B, and C was 75.6±52. 1, 80. 5±58.7, and 97.5±78.7 after 6-month HAART, respectively; and 71.4±58. 9, 110. 8±71.6, and 113.7±88. 3 after 12-month HAART, respectively. Statistical analysis showed no significant difference among three groups （ P 〉 0. 05 ）. The incidence of side effects in groups A, B, and C was 4/32, 14/42, and 32/58 in 3-month HAART, respectively; and 1/32, 8/42, and 22/58 in 3 12 month HAART, respectively. Statistical analysis showed significant difference among three groups （group C 〉 group B 〉 group A, P 〈 0.05 ）. Conclusions It was effective to begin the anti-retroviral treatment in all stages. The incidence of side effects may be less if anti-retroviral treatment began in early period.