HIV耐药患者更换二线方案治疗2年的疗效及安全性评价

Evaluation of efficacy and safety of second-line therapy in HIV/AIDS patients with anti-HIV drug resistance for 2 years

目的了解一线抗病毒治疗耐药的HIV/AIDS患者,更换为二线方案替诺福韦+拉米夫定+克力芝的疗效及安全性。方法 (2005~2011)年所有耐药的HIV/AIDS患者,动态监测更换二线方案后CD_4^+T淋巴细胞计数、CD_8^+8T淋巴细胞计数、病毒载量及不良反应。结果共1 942例接受一线抗病毒治疗,其中22例出现耐药,耐药率为1.1%。22例患者更换二线方案0.5年、1年、2年后CD_4^+T淋巴细胞计数中位数从换药前的176个/μl分别上升至231个/μl(P>0.05)、265个/μl(P<0.05)、285个/μl(P<0.05)。换药半年患者CD_8^+8T淋巴细胞计数中位数从换药前的818个/μl升至1 025个/μl(P<0.05)。换药前患者病毒载量中位数为1×104拷贝/ml,换药后1年、2年病毒载量低于50拷贝/ml的患者例数比例分别为68.2%、90.9%。换药后8例(36.4%)出现毒副反应,其中3例出现消化道症状,3例出现高脂血症,2例出现肾毒性。结论艾滋病耐药患者更换二线药物替诺福韦+拉米夫定+克力芝的免疫学及病毒学疗效显著,但需要密切监测药物毒副反应。

Objective To evaluate the efficacy and safety of the （Tenofovir＋Lamivudine＋Lopinavir/ritonavir） as the second-line antiretroviral treatment in HIV/AIDS（human immunodeficieney virus/acquired immunodeficiency syndrome ）patients with anti-HIV drug resistance. Methods We recruited HIV/AID patients who experienced long term first-line antiretroviral treatments and were resistant to at least one antiretroviral drug from 2005 to 2011. Then changed their therapy to second-line antiretroviral treatment , followed up for two years, and analyzed their CD4^＋T lymphocyte counts ,CDs ＋T lymphocyte counts ,HIV virus load and side effects of antiretroviral drugs. Reaults There were 1942 patients received first-line antiretroviral treatment and 22 of them were resistant to at least one antiretroviral drug, accounted for 1.1%. 22 patients changed their therapy for second-line antiretroviral treatment. The median of CD4^＋T lymphocyte counts was176 cells/μl after half a year for second-line antiretroviral treatment （ P〉0.05 ） ,265 cells/μl （ P〈0.05 ） ,285cells/μl, respectively （ P〈0. 05 ） after second-line antiretroviral treatment for half a year,one year and two years. The median of CD8^ ＋T lymphocyte counts increased from 818 cells/μl to 1025 cells/ μl during half a year for second-line antiretroviral treatment （P〈0.05）. The median of HIV virus load was 1× 10^4 cps/mL before changing treatment. And the ratio of patients whose HIV virus load were lower to 50 cps/mL were 68.2% and 90.9% respectively after treatment changed for one year and two years. 8 patients underwent anti-HIV drug side effect, the incidence rate accounted for 36.4%, of which 3 patients underwent digestive tract symptom, 3 patients underwent hyperlipidemia and 2 patients underwent renal toxicity. Conclusion The immunological and virologic effect of second-line antiretroviral treatment in HIV/ AIDS patients with anti-HIV drug resistance was significant, and their side effect need to be monitored closely and timely.