重庆地区HIV感染者长期选择免费二线药物抗病毒治疗的原因及合理性分析

Rationality analysis of free second-line antiviral treatment for HIV-infected people in Chongqing

目的:了解重庆地区艾滋病免费二线抗病毒药物的使用是否合理。方法:回顾性收集某中心2013-2017年间使用免费二线药物抗HIV治疗患者的临床资料,统计该类患者的比例,分析选择二线药物的原因。结果:筛选出使用二线药物治疗的HIV感染者262例,占同期HIV感染治疗者7.0%,至2018年12月病毒抑制率96.9%,CD4^+T细胞均值(334.5±225.6)个/μL。按初始抗病毒治疗即选用二线药物和由一线药物转换为二线药物分两类,分别有63例(24.0%)、199例(76.0%)。初始选择二线药物因素有合并中枢神经系统疾病(50.8%)、生育需求(20.6%)、肝功能异常(12.7%)、过敏体质(9.5%)、药物间相互作用(DDI)(6.3%);一线药物转换的因素有药物毒副反应(47.8%)、耐药(28.1%)、免疫重建不良(13.6%)、生育需求(8.0%),DDI(2.5%)。因耐药导致转换二线药物者病毒学抑制率达100%;因免疫重建不良更换二线药物者CD4^+T细胞值(209.1±167.5)个/μL较更换方案前[(123.2±62.7)个/μL]明显升高(P<0.05)。结论:重庆地区艾滋病二线药物使用合理,但总体使用者偏少,需提高医务人员认识,对免疫重建不良患者及存在DDI的患者应及时更换抗病毒治疗方案。

OBJECTIVE To understand whether the use of AIDS free second-line antiviral drugs in Chongqing is reasonable.METHODS The clinical data of patients who received anti-HIV treatment with free second-line drugs from 2013 to 2017 in our center were retrospectively collected, and the proportion of such patients as well as the reasons for selecting second-line drugs were analyzed.RESULTS 262 cases of HIV infection were screened out using second-line drug therapy, accounting for 7% of the total HIV infection during the same period. As of December 2018, the virus inhibition rate was 96.9%, The mean CD4^+T cells count was(334.5±225.6) cells/μL. Patients were divided into two groups according to the initial antiviral therapy, with 63 cases(24.0%) and 199 cases(76.0%) in each group, i.e. the second-line drugs and the second-line drugs converted from the first-line drugs. The factors associated with initial second-line drug selection included central nervous system diseases(50.8%), fertility demand(20.6%), liver dysfunction(12.7%), allergic constitution(9.5%) and drug-drug interaction(DDI)(6.3%). the factors for first-line drug conversion were drug toxicity(47.8%), drug resistance(28.1%), poor immune reconstitution(13.6%), fertility need(8.0%), and DDI(2.5%).The virological inhibition rate reached 100% in patients who switched second-line drugs due to drug resistance;CD4^+ T cell values in patients who switched second-line drugs due to poor immune reconstitution(209.1±167.5) cells/μL were significantly higher than those before the regimen switch[(123.2±62.7) cells/μL](P<0.05).CONCLUSION The use of second-line AIDS drugs in Chongqing is reasonable, However, the total number of users is relatively small, so it is necessary to raise the awareness of medical staff. Patients with poor immune reconstitution and patients with DDI should timely converted antiviral treatment.