晚期艾滋病患者使用联合艾博韦泰ART方案效果

Safety and efficacy of albuvirtide containing antiretroviral regimens among AIDS patients at late disease stage

目的了解联合使用艾博韦泰(ABT)的ART方案用于晚期艾滋病患者的安全性和有效性。方法回顾性收集联合使用ABT治疗的晚期艾滋病患者资料,分析临床特征,评估该方案的安全性、有效性,观察后续更换为不含ABT的方案后抗病毒疗效。结果收集182例联合使用ABT进行ART的艾滋病患者,156例(85.7%)合并机会性感染或恶性肿瘤;126例(69.2%)合并脏器功能损伤或慢性基础疾病。平均使用ABT(35.2±9.7)天HIV RNA(2.5log10 copies/mL)较基线显著降低(Z=-7.898,P=0.000),下降了3.1 log10 copies/mL,CD4细胞(113个/μL)较基线显著升高(Z=-4.650,P=0.000),增长了57个/μL;用药期间未发生ABT相关不良事件。停用ABT后60.2%(50/83)转换为整合酶抑制剂为核心的三药方案,37.3%(31/83)转为含NNRTI的方案,治疗1年73.5%的患者HIV RNA<50 copies/mL,CD4细胞(157.0个/μL)较停用ABT时显著升高(Z=-1.947,P=0.049);治疗2年88.0%的患者HIV RNA<50 copies/mL,CD4细胞(241.5个/μL)较治疗1年时显著升高(Z=-2.746,P=0.006)。结论联合ABT的抗病毒治疗方案对晚期艾滋病患者安全性良好,可在1个月内快速降低病毒载量,有助于免疫重建;后续更换为不含ABT的全口服ART方案后免疫功能逐年升高,但ART 2年时仍有较高比例的患者未获得完全病毒学抑制,需密切关注。

Objective To evaluate the safety and efficacy of albuvirtide(ABT)among people with late stage of HIV infection and AIDS.Methods We retrospectively collected data of patients who were at late stage of HIV infection and treated with ABT containing regimens.The clinical characteristics were analyzed,and the safety and efficacy of the treatment regimen were evaluated.The antiviral efficacy of the following replacement of non-ABT regimen was also evaluated.Results 182 people at the late stage of HIV infection who received ABT containing ART regimens were recruited with 156(85.7%)having opportunistic infections or malignant tumors and 126(69.2%)having complicated with organ function deficiency or chronic diseases.After an average of 35.2±9.7 days of ABT containing treatment,HIV RNA significantly decreased from the baseline(Z=-7.898,P=0.000)with an average decrease in 3.1 log10 copies/mL.The CD4 cells was significantly increased from the baseline(Z=-4.650,P=0.000)with an average increase by 57.0 cells/μL.No drug-related adverse events occurred during ABT treatment.After ABT stopped,60.2%(50/83)were switched to a tripledrug regimen containing integrase inhibitors,and 37.3%(31/83)were switched to non-nucleoside reverse transcriptase inhibitor containing triple therapy.After one year of treatment,73.5%of patients had HIV RNA<50 copies/mL and the median CD4 cells(157.0/μL)were significantly higher than the figures when ABT was stopped(Z=-1.947,P=0.049).After two years of treatment,88.0%of patients had HIV RNA<50 copies/mL and the median CD4 cells(241.5/μL)were significantly higher than that after one year of treatment(Z=-2.746,P=0.006).Conclusions The antiviral therapy with ABT is safe for patients at the late stage of HIV infection.The regimen can rapidly reduce HIV RNA within a month and help immune reconstruction.During the follow-up after ABT being switched to triple ART regimen,the immune function increased significantly with the time.However,we should pay an attention that about 12%of patients did not obtain a complete virological inhibition after two years of treatment switch.