含替诺福韦的一线HAART方案治疗HIV感染/AIDS患者的疗效及治疗失败的影响因素

Efficacy of first-line HAART regimen containing tenofovir and influencing factors of treatment failure in HIV infected/AIDS patients

目的探讨含替诺福韦的一线高效抗逆转录病毒治疗(HAART)方案治疗HIV感染/AIDS患者的疗效及治疗失败的影响因素。方法选择首次接受HAART的409例HIV感染/AIDS患者,以HAART方案是否包含替诺福韦将患者分为替诺福韦组169例和非替诺福韦组240例。比较两组治疗24个月内治疗失败情况以及免疫学、病毒学应答效果。采用Logistic回归模型分析HAART治疗失败的影响因素。结果治疗24个月内,替诺福韦组治疗失败率、病毒学失败率、免疫学失败率均低于非替诺福韦组(均P<0.05)。治疗后第3、6、9、12、18、24个月,两组的CD4+T淋巴结细胞和CD8+T淋巴细胞计数均较基线时升高,且在治疗第3、6、9、12个月时,替诺福韦组CD4+T淋巴细胞计数高于非替诺福韦组(均P<0.05)。基线CD4+T淋巴细胞计数低、HAART初始方案未包含替诺福韦是HAART治疗失败的危险因素(均P<0.05)。结论含替诺福韦的一线HAART方案治疗HIV感染/AIDS患者时应答效果优于不含替诺福韦的方案,其可降低HAART治疗失败率,并可在较短时间内促进免疫重建。

Objective To explore the efficacy of first-line highly active antiretroviral therapy(HAART) regimen containing tenofovir and the influencing factors of treatment failure in HIV infected/AIDS patients. Methods A total of 409 HIV-infected/AIDS patients with initial HAART were enrolled.All patients were divided into tenofovir group( n =169) and non-tenofovir group( n =240) according to the presence of tenofovir in HAART regimen.Incidence of treatment failure within 24 months of treatment as well as immunological and virological response efficacy was compared between the two groups.Logistic regression model was used to analyze the influencing factors of HAART failure. Results Within 24 months of treatment,the tenofovir group had lower rates of treatment failure,virological failure,and immunological failure than the non-tenofovir group(all P <0.05).CD4 +T lymphocyte and CD8 +T lymphocyte counts were increased in both groups at 3,6,9,12,18 and 24 months after treatment compared with the baseline,moreover, CD4 +T lymphocyte counts in the tenofovir group at 3,6,9 and 12 months after treatment were higher than those in the non-TDF group (all P <0.05). Low baseline CD4 +T lymphocyte count and initial tenofovir-free HAART regimen were risk factors for failure in HAART treatment(all P <0.05). Conclusion The first-line HAART regimen containing tenofovir is superior to the first-line HAART regimen without tenofovir in response efficacy for HIV-infected/AIDS patients ,and it can reduce the incidence of HAART failure and promote immune reconstruction in a relatively short time.