河南省81例HCV／HIV共感染者接受艾滋病二线抗病毒治疗效果及HIV耐药性分析

Effect of treatment and HIV drug resistance of 81 cases of HCV/HIV co-infected individuals who had received AIDS second-line antiretroviral treatment in Henan province

目的 了解HCV/HIV共感染者在艾滋病一线抗病毒治疗病毒学失败后更换二线治疗方案一年内的效果和耐药情况.方法 招募2012年5-10月间河南省新蔡、确山和尉氏3县中HIV/HCV抗体阳性且使用一线艾滋病抗病毒治疗方案一年后病毒载量未得到抑制的患者.患者更换艾滋病二线治疗方案后6个月和12个月时进行随访和CD4＋T淋巴细胞计数、HIV病毒载量和HIV耐药性检测.结果 符合条件的81例HIV/HCV共感染者的CD4＋T淋巴细胞中位数在更换二线药物6个月、12个月后出现回升;基线、6个月和12个月的CD4＋T淋巴细胞中位数分别为266cells/μl、275 cells/μl和299 cells/μl（x2=8.214,P=0.009）;HIV病毒载量得到抑制的患者比例分别上升到6个月、12个月的46.84％、50.00％.HIV耐药发生率显著下降,基线、6个月和12个月的耐药发生率分别为66.67％、26.58％和27.63％（x2=29.362,P=0.000）;同时NRTI和NNRTI耐药的发生率均下降,基线、6个月和12个月的发生率分别为51.85％、18.99％和17.11％（x2=14.230,P=0.005）.81例患者在基线时对NRTI中3TC、ABC和FTC的耐药发生率都在50％以上,对AZT、D4T和DDI的耐药发生率在41％-44％之间,对TDF的耐药发生率为33.33％,6个月和12个月后下降到12％- 18％.患者基线时对NNRTI中NVP和EFV的耐药率都达到65.43％,而在更换二线药物6个月和12个月后都下降到24％ - 27％.结论 发生一线艾滋病抗病毒治疗病毒学失败的HIV/HCV共感染者在更换二线治疗方案6个月后状况得到了改善,但是在12个月后治疗效果改善有限。

Objective To understand the one-year effect of HCV/HIV co-infected patients who had received AIDS second-line antiretroviral treatment after failure virologically,on the first-line therapy.Methods HCV and HIV antibody positive patients who had experienced virological failure but received at least one-year AIDS first-line treatment,were recruited from May to October 2012 in Xincai,Queshan and Weishi of Henan province.6-months and 12-months follow-up programs were carried out after the regimen had been changed to AIDS second-line antiretroviral treatment,CD4 ＋T lymphocyte count,HIV-1 virus load and HIV-1 drug resistance were performed.Results Eighty-one cases of eligible patients were selected and followed by an amelioration of CD4 median at 6-month and 12-month follow-up period.Data showed that the baseline,6-months and 12-months CD4 medians were 266 cells/μl,275 cells/μl and 299 cells/μl （x2=8.214,P =0.009）.The ratio of HIV virus load suppression patients at 6-months and 12-months follow-up increased to 46.84% and 50.00%,respectively.Frequencies of HIV drug resistance also decreased at the baseline,6-months and 12-months,with ratios as 66.67%,26.58% and 27.63%（x2=29.362,P=0.000）,respectively.Ratios of patients that holding NRTI and NNRTI drug resistance appeared coinstantaneous decrease at the baseline,6-months and 12-months,as 51.85%,18.99% and 17.11%（x2=14.230,P=0.005）.At the baseline,the ratios of patients resisted to 3TC,ABC and FTC were all more than 50%,with AZT,D4T and DDI between 41%-44% while TDF appeared as 33.33%,then all of them declined to 12%-18% at the 6-month and 12-month follow-up periods.65.43% of the patients resisted to both NVP and EFV but declined to 24%-27% at 6 months and 12 months.Conclusion HCV/HIV co-infected patients experienced virological failure of AIDS first-line therapy were ameliorated after changing to use second-line antiretroviral treatment for 6-months,but did not show constant positive effect at the 12-month end point.