HIV耐药病人更换含洛匹那韦/利托那韦治疗5年的疗效分析

Five-year clinical efficacy analysis of antiretroviral therapy regimen containing lopinavir/ritonavir among patients with drug-resistant HIV infection

目的分析艾滋病病毒(HIV)耐药病人更换为含洛匹那韦/利托那韦(LPV/r)的高效抗反转录病毒治疗(HAART)后的远期疗效。方法采用前瞻性队列研究方法,纳入存在HIV耐药突变的HIV感染者/艾滋病(AIDS)病人39例,将治疗方案更换为含有LPV/r的抗病毒方案,分别在更换方案的0、6、12、18、24、36、48、60个月时进行CD+4T淋巴细胞计数、HIV-核糖核酸(RNA)及HIV耐药检测。结果 39例病人更换方案前CD+4T淋巴细胞中位数为223个/μL,HIV-RNA中位数为6500拷贝/mL。更换方案后CD+4T淋巴细胞中位数随着治疗时间延长而不断增加,且与更换方案前比较差异有统计学意义(P<0.05)。HIV-RNA<50拷贝/mL的病人的比例,在更换方案后6、12、18、24、36、48、60个月分别为76.92%(30/39)、89.19%(33/37)、92.11%(35/38)、86.49%(32/37)、84.38%(27/32)、90.32%(28/31)和93.55%(29/31)。在治疗过程中未出现蛋白酶抑制剂耐药突变。结论HIV耐药病人更换为含有LPV/r的治疗方案可获得良好的长期疗效,且不易发生蛋白酶抑制剂耐药突变。

Objective The present study was designed to evaluate the long-term efficacy of highly active antiretroviral therapy（HAART）containing lopinavir/ritonavir（LPV/r）as the alternative treatment in human immunodeficiency virus（HIV）-infected patients with drug resistance.Methods This study was a prospective cohort trial.HIV drug-resistance mutations were detected in 39 AIDS patients,who were administered with the HAART containing LPV/r.The CD＋4T lymphocyte counts,HIV RNA level,and HIV drug resistance were measured before the LPV/r treatment and after 6,12,18,24,36,48 and 60months of the alternative treatment.Results The median CD＋4T lymphocyte counts and median HIV RNA level at baseline before the LPV/r treatment were 223cells/μL and 6500copies/mL,respectively.Following the alternative treatment,the median CD＋4T lymphocyte counts were clearly increased at each time point as compared to the pretreatment value（P 〈0.05）.In addition,the number of patients with HIV RNA level less than 50copies/mL were 30（76.92%）,33（89.19%）,35（92.11%）,32（86.49%）,27（84.38%）,28（90.32%）,and 29（93.55%）after 6,12,18,24,36,48 and 60months of LPV/r treatment.Besides,protease inhibitor mutations were not found during the treatment period.Conclusion The longterm efficacy of LPV/r as the alternative therapy for HIV-infected patients with drug resistance was improved,with no involvement of protease inhibitor mutations.