282例HIV/AIDS患者TDF+3TC+EFV初始抗病毒治疗效果分析
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摘要
目的探讨替诺福韦(TDF)+拉米夫定(3TC)+依非韦伦(EFV)初始高效抗反转录病毒治疗(HAART)的近期疗效。方法建立前瞻性研究队列,纳入300例HIV/AIDS成年患者,给予TDF+3TC+EFV初始HAART 48周,对最终完成治疗、随访患者的HIV病毒载量(VL)、CD4+T淋巴细胞计数(CD4+)进行分析,高基线VL(VL≥105拷贝/mL)组定义为A组,低基线VL(VL<105拷贝/mL)组定义为B组。结果最终282例患者完成48周治疗及随访,98.58%患者坚持每天定时服药。HAART 12周HIV病毒抑制率(VL<40拷贝/mL的所占比例)为46.53%,48周为98.58%;A、B两组HIV病毒抑制率在HAART 12周分别为10.81%、58.88%,差异有统计学意义(P<0.05),48周分别为98.61%、98.57%,差异无统计学意义(P>0.05)。基线、24周、48周CD4+平均值分别为(317.98±119.31)、(453.10±165.46)、(474.98±165.56)个/μL,差异有统计学意义(P<0.05);24周较基线、48周较基线、48周较24周CD4+均增长,HAART 24周CD4+增长幅度更大;HAART 48周CD4+≥350个/μL患者比例明显上升,由基线时42.55%上升至79.08%;HAART 48周CD4+较基线CD4+增长大于或等于100个/μL患者占66.31%。结论 TDF+3TC+EFV作为成人初始HAART方案,短期内能有效控制患者血浆中HIV病毒复制及升高外周CD4+,近期抗病毒治疗疗效显著。
Objective To explore the curative therapeutic efficacy of TDF+3 TC+EFV HAART as initial treatment in naive HIV/AIDS patients.Methods 300 HIV/AIDS adult patients were included in a prospective study cohort,which was given TDF+3 TC+EFV as an initial HAART for 48 weeks.The HIV viral load(VL)and CD4+T lymphocyte count(CD4+)of the patients who were finally treated and followed-up were analyzed.The high baseline viral load(VL≥105 copies/mL)group was defined as group A and the low baseline viral load(VL<105 copies/mL)group was defined as group B.Results 282 patients finished 48 weeks treatment and followed-up,and 98.58%of them took the medicine regularly every day.At the HAART12 th week,the percentage of patients with viral load<40 copies/μL was 46.53%.When at the 48 th week,the percentage was 98.58%.At the 12 th week,the HIV viral suppression rate of group A was 10.81%,the B group was 58.88% which has a significance statistically(P<0.05).When at the 48 th week,the viral suppression rate of two groups was similar,with no significant(P>0.05).The average CD4+T cell counts at the baseline,24 th week,48 th week was(317.98±119.31),(453.10±165.46),(474.98±165.56)cells/μL respectively,with significant increasing(P<0.05).CD4+T cells increased at the 24 th week compared to baseline,the 48 th week compared to baseline,the 48 th week compared to the 24 th week.In addition,the amplification of CD4+T significant increased at the 24 th week after HAART.The proportion CD4+>350 cells/μL at HAART 48 th week increased significantly from 42.55%to 78.08% at HAART 48 th week.After 48 weeks treatment,the percentage of patients whose CD4+improved more than 100 cells/μL was 66.31%.Conclusion TDF+3 TC+EFV as the initial HAART can quickly decrease viral load in plasma and increase CD4+in a short term,the effecy of curative anti-viral treatment is outstanding.
Objective To explore the curative therapeutic efficacy of TDF+3 TC+EFV HAART as initial treatment in naive HIV/AIDS patients.Methods 300 HIV/AIDS adult patients were included in a prospective study cohort,which was given TDF+3 TC+EFV as an initial HAART for 48 weeks.The HIV viral load(VL)and CD4+T lymphocyte count(CD4+)of the patients who were finally treated and followed-up were analyzed.The high baseline viral load(VL≥105 copies/mL)group was defined as group A and the low baseline viral load(VL<105 copies/mL)group was defined as group B.Results 282 patients finished 48 weeks treatment and followed-up,and 98.58%of them took the medicine regularly every day.At the HAART12 th week,the percentage of patients with viral load<40 copies/μL was 46.53%.When at the 48 th week,the percentage was 98.58%.At the 12 th week,the HIV viral suppression rate of group A was 10.81%,the B group was 58.88% which has a significance statistically(P<0.05).When at the 48 th week,the viral suppression rate of two groups was similar,with no significant(P>0.05).The average CD4+T cell counts at the baseline,24 th week,48 th week was(317.98±119.31),(453.10±165.46),(474.98±165.56)cells/μL respectively,with significant increasing(P<0.05).CD4+T cells increased at the 24 th week compared to baseline,the 48 th week compared to baseline,the 48 th week compared to the 24 th week.In addition,the amplification of CD4+T significant increased at the 24 th week after HAART.The proportion CD4+>350 cells/μL at HAART 48 th week increased significantly from 42.55%to 78.08% at HAART 48 th week.After 48 weeks treatment,the percentage of patients whose CD4+improved more than 100 cells/μL was 66.31%.Conclusion TDF+3 TC+EFV as the initial HAART can quickly decrease viral load in plasma and increase CD4+in a short term,the effecy of curative anti-viral treatment is outstanding.
引文
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[14]李健健,杨绍敏,张米,等.云南省2007-2012年HIV/AIDS高效联合抗病毒治疗效果及药物不良反应分析[J].中华流行病学杂志,2013,34(10):1045-1046.
[15]MAMAN D,PUJADES-RODRIGUEZ M,NICHOLASS,et al.Response to antiretroviral therapy:improved survival associated with CD4above 500cells/μL[J].AIDS,2012,26(11):1393-1398.
[16]MILLS E J,BAKANDA C,BIRUNGI J,et al.The prognostic value of baseline CD4(+)cell count beyond 6months of antiretroviral therapy in HIV-positive patients in a resource-limited setting[J].AIDS,2012,26(11):1425-1429.
[17]TARWATER P M,MARGOLICK J B,JIN J,et al.Increase and plateau of CD4T-cell counts in the 3(1/2)years after initiation of potent antiretroviral therapy[J].J Acquir Immune Defic Syndr,2001,27(2):168-175.
[2]RAO K V,CHITTURI R T,KATTAPPAGARI K K,et al.Impact of highly active antiretroviral therapy on oral manifestations of patients with human immunodeficiency virus/acquired immune deficiency syndrome in South India[J].Indian J Sex Transm Dis,2015,36(1):35-39.
[3]中国疾病预防控制中心,性病艾滋病预防控制中心,性病控制中心.2016年11月全国艾滋病性病疫情[J].中国艾滋病性病,2017,23(1):1.
[4]CHIAP P E,BERTI E,GIANESIN K,et al.Pediatric human immunodeficiency virus infection and cancer in the highly active antiretroviral treatment(HAART)era[J].Cancer Lett,2014,347(1):38-45.
[5]豆智慧,张福杰,赵燕,等.2002-2014年中国免费艾滋病抗病毒治疗进展[J].中华流行病学杂志,2015,36(12):1345-1350.
[6]国家免费艾滋病抗病毒药物治疗手册编写组.国家免费艾滋病抗病毒药物治疗手册[M].3版.北京:人民卫生出版社,2012:17-18.
[7]中华医学会感染病学分会艾滋病学组.艾滋病诊疗指南第三版(2015版)[J].中华临床感染病杂志,2015,8(5):385-401.
[8]World Health Organization.Consolidated guidelines on HIVprevention,diagnosis,treatment and care for key populations-2016update[R].Geneva:World Health Organization,2016.
[9]隆素素,席娜娜,左宗力,等.抗病毒治疗1年后的疗效评价及病毒抑制失败影响因素分析[J].中国艾滋病性病,2015,17(12):1004-1007.
[10]NACHEGA J B,HISLOP M,DOWDY D W,et al.Efavirenz versus nevirapine-based initial treatment of HIV infection:clinical and virologial outcomes in Southern African adults[J].AIDS,2008,22(16):2117-2125.
[11]SAX P E,TIERNEY C,COLLIER A C,et al.Abacavir/lamivudine versus tenofovir DF/emtricitabine as part of combination regimens for initial treatment of HIV:final results[J].J Infect Dis,2011,204(8):1191-1201.
[12]姚仕堂,杨锦,周琳,等.云南省德宏州抗病毒治疗艾滋病患者血浆病毒载量及耐药研究[J].中华流行病学杂志,2014,35(4):411-416.
[13]DIOP S A,FORTES-DEGUENONVO L,SEYDI M,et al.Efficacy and tolerance of tenofovir-lamivudine-efavirenz combination in HIV-1patients in Fann teaching hospital in dakar[J].Bull Soc Pathol Exot,2013,106(1):22-26.
[14]李健健,杨绍敏,张米,等.云南省2007-2012年HIV/AIDS高效联合抗病毒治疗效果及药物不良反应分析[J].中华流行病学杂志,2013,34(10):1045-1046.
[15]MAMAN D,PUJADES-RODRIGUEZ M,NICHOLASS,et al.Response to antiretroviral therapy:improved survival associated with CD4above 500cells/μL[J].AIDS,2012,26(11):1393-1398.
[16]MILLS E J,BAKANDA C,BIRUNGI J,et al.The prognostic value of baseline CD4(+)cell count beyond 6months of antiretroviral therapy in HIV-positive patients in a resource-limited setting[J].AIDS,2012,26(11):1425-1429.
[17]TARWATER P M,MARGOLICK J B,JIN J,et al.Increase and plateau of CD4T-cell counts in the 3(1/2)years after initiation of potent antiretroviral therapy[J].J Acquir Immune Defic Syndr,2001,27(2):168-175.