HIV合并HBV感染的患者抗病毒治疗效果分析

Clinical effect of HAART treatment on AIDS patients co-infected with HBV

目的评价替诺福韦(TDF)+拉米夫定(3TC)+依菲韦伦(EFV)或TDF+3TC+克力芝(LPV/r)治疗方案,对艾滋病病毒(HIV)合并感染乙型肝炎病毒(HBV)患者的治疗效果,对合并感染者死亡因素进行分析,为临床抗病毒治疗提供参考。方法对46例HIV/HBV合并感染患者实施TDF+3TC+EFV或TDF+3TC+LPV/r方案治疗,治疗3、6、12个月后随访,分析CD4+T淋巴细胞、HIV RNA、HBV DNA、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)等指标的变化。结果 46例HIV/HBV合并感染患者治疗3、6、12个月后,CD4+T淋巴细胞数分别增加了76个/μL、138个/μL和145个/μL;治疗6、12个月后,HIV-RNA抑制率分别为79.49%和95.56%,HBV-DNA抑制率分别为77.14%和97.06%;抗病毒治疗12个月内AST、ALT先升后降,治疗6个月时,除2例肝功能异常外,其余肝功均复常;HIV/HBV合并感染者病死率为10.87%。结论 TDF+3TC+EFV或TDF+3TC+LPV/r方案对HIV和HBV均有很强的抑制作用,是一种高效、安全的治疗HIV/HBV合并感染的首选方案。

Objective To evaluate the treatment effect of TDF＋3TC＋EFV or TDF＋3TC＋LPV/r among HIV/HBV patients,and analyze death related factors of the AIDS patients co-infected with HBV so as to provide evidence for improving clinic treatment to HIV/HBV patients.Methods A series of information were collected from 46HIV/HBV patients including CD4＋T lymphocyte,HIV-RNA,HBV-DNA,AST,ALT after three,six,and twelve months of highly actively anti-retroviral therapy（HAART）initiation and then the treatment effect was analyzed.Results After HAART initiation for three,six,and twelve months,the HIV/HBV patients showed increased CD4＋ T lymphocyte by76/μL,138/μL,and 145/μL.After the treatment lasted for six and twelve months,HIV-RNA suppression rate was79.49%,and 95.56%,and HBV-DNA suppression rate was 77.14%,and 97.06%.Within the twelve month of HAART,AST/ALT level raised first and fell later.After six-month therapy,only two patients had malfunction on their liver and the rest recovered their liver function.The mortality rate of HIV/HBV patients was 10.87%.Conclusion TDF＋3TC＋EFV or TDF＋3TC＋LPV/r treatment has a very strong effect on inhibiting HIV and HBV.It is proved to be an effective and safe therapy for HIV/HBV infection.