中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2011年
4期
197-200
,共4页
卢瑞朝%张勇%李虹如%徐彩玲%窦艳云%蔡卫平
盧瑞朝%張勇%李虹如%徐綵玲%竇豔雲%蔡衛平
로서조%장용%리홍여%서채령%두염운%채위평
人免疫缺陷病毒%肝炎病毒,丙型%高效抗反转录病毒治疗
人免疫缺陷病毒%肝炎病毒,丙型%高效抗反轉錄病毒治療
인면역결함병독%간염병독,병형%고효항반전록병독치료
Human immunodeficiency virus%Hepatitis C virus%Highly active antiretroviral therapy
目的 探讨人免疫缺陷病毒(HIV)和丙型肝炎病毒(HCV)合并感染者高效抗反转录病毒治疗(HAART)的疗效.方法 采用双盲法随机选择HIV/HCV合并感染者63例(A组),单纯HIV感染者62例(B组).其中A组通过Spw-Pb网络数据平台按1∶1∶1随机分为A1、A2和A3组,分别采用以奈韦拉平(NVP)、依非韦伦(EFV)和洛匹那韦/利托那韦(LPV/r)为基础的三种HAART方案治疗.观察免疫学、病毒学指标及不良反应发生率.采用SPSS 13.0软件进行统计学分析.多组间比较采用One-way ANOVA,组间两两比较采用LSD-t检验.结果 治疗48周后,A组HIV RNA转阴率为93.7% (59/63),B组为98.4%( 61/62),两组间比较差异无统计学意义(x2=0.159,P>0.05);A组CD4 +T淋巴细胞计数为(208±77)个/μL,明显低于B组(263±78)个/μL(t=-2.759,P =0.008);A组ALT均值为(57±49) U/L,明显高于B组(31±14) U/L(t =2.027,P=0.047);A3组CD4 +T淋巴细胞计数明显高于A1组,差异有统计学意义(t=-2.191,P=0.045);A1组ALT均值高于A2、A3组,差异有统计学意义(t=2.568和2.478,P值均<0.05).HIV/HCV合并感染组治疗过程中药物性肝炎的发生率明显高于HIV单纯感染组(55.5%vs.27.4%),两组比较差异有统计学意义(x2= 10.182,P=0.001).结论 HIV/HCV合并感染不影响HAART的病毒学疗效,但可能影响患者的免疫重建.HIV/HCV感染者HAART期间肝脏毒性反应较常见,尤以NVP方案明显.推荐HIV/HCV感染者采用LPV/r的HAART方案.
目的 探討人免疫缺陷病毒(HIV)和丙型肝炎病毒(HCV)閤併感染者高效抗反轉錄病毒治療(HAART)的療效.方法 採用雙盲法隨機選擇HIV/HCV閤併感染者63例(A組),單純HIV感染者62例(B組).其中A組通過Spw-Pb網絡數據平檯按1∶1∶1隨機分為A1、A2和A3組,分彆採用以奈韋拉平(NVP)、依非韋倫(EFV)和洛匹那韋/利託那韋(LPV/r)為基礎的三種HAART方案治療.觀察免疫學、病毒學指標及不良反應髮生率.採用SPSS 13.0軟件進行統計學分析.多組間比較採用One-way ANOVA,組間兩兩比較採用LSD-t檢驗.結果 治療48週後,A組HIV RNA轉陰率為93.7% (59/63),B組為98.4%( 61/62),兩組間比較差異無統計學意義(x2=0.159,P>0.05);A組CD4 +T淋巴細胞計數為(208±77)箇/μL,明顯低于B組(263±78)箇/μL(t=-2.759,P =0.008);A組ALT均值為(57±49) U/L,明顯高于B組(31±14) U/L(t =2.027,P=0.047);A3組CD4 +T淋巴細胞計數明顯高于A1組,差異有統計學意義(t=-2.191,P=0.045);A1組ALT均值高于A2、A3組,差異有統計學意義(t=2.568和2.478,P值均<0.05).HIV/HCV閤併感染組治療過程中藥物性肝炎的髮生率明顯高于HIV單純感染組(55.5%vs.27.4%),兩組比較差異有統計學意義(x2= 10.182,P=0.001).結論 HIV/HCV閤併感染不影響HAART的病毒學療效,但可能影響患者的免疫重建.HIV/HCV感染者HAART期間肝髒毒性反應較常見,尤以NVP方案明顯.推薦HIV/HCV感染者採用LPV/r的HAART方案.
목적 탐토인면역결함병독(HIV)화병형간염병독(HCV)합병감염자고효항반전록병독치료(HAART)적료효.방법 채용쌍맹법수궤선택HIV/HCV합병감염자63례(A조),단순HIV감염자62례(B조).기중A조통과Spw-Pb망락수거평태안1∶1∶1수궤분위A1、A2화A3조,분별채용이내위랍평(NVP)、의비위륜(EFV)화락필나위/리탁나위(LPV/r)위기출적삼충HAART방안치료.관찰면역학、병독학지표급불량반응발생솔.채용SPSS 13.0연건진행통계학분석.다조간비교채용One-way ANOVA,조간량량비교채용LSD-t검험.결과 치료48주후,A조HIV RNA전음솔위93.7% (59/63),B조위98.4%( 61/62),량조간비교차이무통계학의의(x2=0.159,P>0.05);A조CD4 +T림파세포계수위(208±77)개/μL,명현저우B조(263±78)개/μL(t=-2.759,P =0.008);A조ALT균치위(57±49) U/L,명현고우B조(31±14) U/L(t =2.027,P=0.047);A3조CD4 +T림파세포계수명현고우A1조,차이유통계학의의(t=-2.191,P=0.045);A1조ALT균치고우A2、A3조,차이유통계학의의(t=2.568화2.478,P치균<0.05).HIV/HCV합병감염조치료과정중약물성간염적발생솔명현고우HIV단순감염조(55.5%vs.27.4%),량조비교차이유통계학의의(x2= 10.182,P=0.001).결론 HIV/HCV합병감염불영향HAART적병독학료효,단가능영향환자적면역중건.HIV/HCV감염자HAART기간간장독성반응교상견,우이NVP방안명현.추천HIV/HCV감염자채용LPV/r적HAART방안.
Objective To investigate the efficacy of highly active antiretroviral therapy (HAART) for HIV/HCV co-infection patients. Methods A randomized and double blinded trial was conducted in sixty-three HIV/HCV co-infected patients ( group A) and 62 HIV infected patients ( group B). The group A (study group) was further divided into A1, A2, A3 subgroups randomly by Spw-Pb network data system, and were given three different HAART regimens based on nevirapine (NVP), efavirenz (EFV) and lopinavir/ritonavir(LPV/r), respectively. CD4+ T lymphocyte counts, HIV virus load, glutamate-pyruvate transaminase (ALT) were detected at baseline and at the endpoint of study (48 weeks). SPSS 13.0 was used for statistical analysis. One-way ANOVA and LSD-t tests were performed. Results After 48 weeks treatment, HIV RNA became negative in 59 patients of group A (59/63, 93.7% ), while that in group B was 61 (61/62, 98.4% ) (x2 =0. 159, P > 0.05 ). CD4+ T lymphocyte count in group A was (208 ± 77 )/μL, which was significantly lower than that in group B (263 ± 78)/μL (t =-2. 759, P = 0. 008 ).ALT level in group A was (57 ±49)U/L, which was significantly higher than in group B (31 ± 14) U/L (t = 2. 027, P = 0.047). CD4 + T lymphocyte count in group A3 was significantly higher than that in A1 (t=-2. 191, P =0.045), while ALT level in A1 was much higher than that in subgroups A2 and A3 ( t = 2.568 and 2.478, P < 0. 05 ). The incurrence of drug-induced hepatitis in HIV/HCV co-infected group was much higher than that in HIV infected group (55.5% vs. 27.4%, x2 = 10. 182, P = 0.001 ).Conclusions HCV co-infection in HIV patients shows no impact on virological response to HAART, but the immunological response is poorer. Hepatotoxicity is common among patients receiving HAART, especially those who are receiving NVP containing regimens. LPV/r based regimens are recommend for HIV/HCV coinfected patients.