美沙酮维持治疗门诊开展HIV感染者抗病毒治疗的临床观察

Clinical study on anti-HIV treatment of methadone maintenance in clinic

目的:探讨美沙酮维持门诊服药人群中,对HIV感染者实施抗病毒治疗的临床观察,提高治疗依从性,降低死亡率。方法:选择服用美沙酮的HIV感染者为实施抗HIV病毒治疗的对象,按照抗病毒治疗的有关规范实施抗病毒治疗,定期做相关检测、心理、行为干预和效果评估。结果:累计入组实施治疗119人,脱失29人,维持治疗率为75.63%。现在这90人的服药情况中,73例完全依从,15例依从性良好,2例依从性差,总的服药依从性为97.78%。抗HIV病毒治疗后患者的CD4+T淋巴细胞水平为(121.06±53.70)个/mm^3增至(246.82±130.15)个/mm^3;随着治疗期的增加,患者体内的CD4+T淋巴细胞水平逐渐升高,(P<0.05)具有统计学意义。90例在治患者经过实验室检测,85例患者HIV病毒的VL完全抑制(VL水平#400 copies/ml),5例未能降至完全抑制水平,治疗有效率为94.44%。结论:依托美沙酮门诊的管理和信息平台,充分利用医院专业技术人员优势和医技检查设备的支持,对美沙酮维持治疗门诊中的HIV感染者实施抗病毒治疗是可行的,具有较好的可操作性,接受抗病毒治疗者依从性较好。

Objective： To investigate the clinical observation of antiviral therapy for HIV-infected people in the patients with methadone maintenance in the outpatient service and to improve the compliance and reduce the mortality.Methods： Choose HIV infection personnel in methadone maintenance clinics as the research object to receive antiviral treatment. During this period we made related detection regularly,at same time we made psychological, behavioral intervention to evaluate the effect of treatment.Results： A total of 119 patients were enrolled in the group,29 were lost,and the treatment rate was 75. 63 percent. In the treatment of 90 people,73 of them were completely compliant,15 were good in compliance,2 had poor compliance,and the total drug compliance was 97. 78%. Anti-HIV treatment after the patient＇s level of CD4＋T lymphocytes for ± 121. 06（ 53. 70）/mm^3 to（ ± 246. 82.246. 82）/mm^3; With the increase of treatment period,patients with CD4＋T cells in the body level increased,with statistical significance（ P〈0. 05）. 90 cases in the treated patients through laboratory tests,85 cases of patients with HIV VL complete inhibition（ #VL level 400 copies/ml）,5 cases failed to fall to completely inhibit level,treatment effective rate was 94. 44%.Conclusion： Antiviral treatment of the HIV positives in methadone maintenance treatment clinic is feasible thanks to the help of methadone clinics management and information platform. We made full use of hospital resources include the professional and technical personnel and medical inspection equipment throughout the process. This project has better maneuverability and social benefits.