云南省抗病毒治疗中病毒抑制但免疫失败的AIDS病人更换二线药后的免疫学效果分析

Immune response after a switch to the 2^(nd) line regimen amongst the AIDS patients with HIV suppression but immune failure under antiretroviral therapy in Yunnan province

目的了解在联合抗病毒治疗(ART)中病毒抑制但免疫失败的艾滋病(AIDS)病人,通过更换二线药方案后其免疫功能恢复情况,并对影响因素进行初步分析。方法按照纳入标准,选取了云南省免费抗病毒治疗的≥15岁青少年和成人AIDS病人的部分数据,回顾性分析CD4^+T淋巴细胞(简称CD4细胞)计数相较于换药前的变化情况。结果纳入分析的331例病人,启动ART时CD4细胞计数平均值是171.5个/mm^3(59.2%<200个/mm^3),更换含洛匹那韦/利托那韦的二线药方案前,CD4细胞计数平均值降低到125.3个/mm^3(86.4%<200个/mm^3),更换后CD4细胞计数增加到200个/mm^3以上。其中换药后第12、18、24、30、36、42和48个月,CD4细胞计数增加的平均值(个/mm^3)和[95%可信区间(CI)]分别为102.5(83.0,122.1)、123.0(95.9,150.2)、140.4(101.9,178.9)、145.6(96.0,195.2)、125.4(53.2,197.5)、179.9(96.0,263.8)和236.0(37.9,434.1)个/mm^3。以更换二线药前的CD4细胞计数作为协变量分析,启动ART时年龄≤50岁与>50岁的比较,CD4细胞计数增加的平均值(个/mm^3)和(95%CI)是65.8(17.61,113.92),计数增加的差异有统计学意义(P=0.008);启动ART时CD4细胞计数≤50个/mm^3组和50~100个/mm^3组分别与>200个/mm^3组比较,CD4细胞计数增加的平均值(个/mm^3)和(95%CI)分别是-120.0(-192.31,-47.76)和-73.3(-143.56,-3.07),计数增加的差异均有统计学差异(P=0.001和P=0.041)。结论更换洛匹那韦/利托那韦的二线药方案,可以使病毒抑制但免疫失败的艾滋病病人的CD4细胞计数增加;启动ART时≤50岁者,其CD4细胞计数增加的程度大于年龄更大的病例;启动ART时CD4细胞>200个/mm^3的病例,换药后CD4细胞计数增加的程度大于初始时CD4细胞≤100个/mm^3者。

Objective To learn about the immune response after a switch to the 2^nd line regimen amongst the AIDS patients with HIV suppression but immune failure under combined antiretroviral therapy （ART） and the relat ed factors. Methods Data of ART cases above 15-year-old were selected and retrospectively the CD4^＋ T counts were compared after the switch of 2nd line regimen with I.opinavir/Ritonavir. Results Among 331 cases involved in the analysis, the average CD4^＋ T count of 171.5 cells/mm^3 （59.2%〈200 cells/mm^3） at ART initiation, dropped to 125.3 cells/mm^3（86.4%〈200 cells/mm^3） before the switch, and then rose to above 200 cells/mm^3 after the switch. The average change of count （95% CI） in the 12^th, 18^th, 24^th, 30^th, 36^th, 42^th, 48^th month was 102.5 （83.0, 122.1）, 123.0（95.9, 150.2）,140.4（101.9, 178.9）,145.6（96.0, 195.2）, 125.4（53.2, 197.5）. 179.9 （96.0, 263.8）and 236.0（37.9, 434. 1） respectively. The findings of ancova model showed that comparing the arm with age〉 50 year-old and arm with the ≤50 year-old of initiating ART, at month 12 of post-switch, CD4 cell count of change （95% CI） wag 65.8 （17.61, 113.92） and P--0. 008. According to the CD4 count ot＂ ART initiation, comparing the ≤50 cells/rama arm and 50%CD4 ≤100 cells/mma arm to the〉200 cells/mm^3 arm respectively, the change of CD4 cell count （95% CI） was -120.0 （-192.31, -47.76） and -73.3 （-143.56, -3.07）,P--0. 001 and P=0. 041. Conclusion The ART patients with HIV suppression but immune failure will increase CD4 count after switch to the 2^nd line regimen; and the count increase will be more if patients initiate ART with age 50-year-old; the baseline CD4〉200 cells/mm^3 will have higher magnitude of CD4 count compared to the baseline CD4〈100 cells/mma.