CAJ | 학술논문

目的分析河南省更换抗病毒治疗方案的艾滋病患者治疗状况.方法选择84例接受国家免费一线抗病毒治疗5年以上即将更换治疗方案的艾滋病患者进行基线调查,6个月后随访.调查项目主要包括CD4+T淋巴细胞计数、病毒载量和基因型耐药.结果基线调查时84例患者均使用早期一线方案(DDI+ AZT+ NVP),一周内31例患者开始使用后期一线方案(3TC+AZT+NVP),53例患者开始使用二线方案(3TC+TDF+LPV/r).6个月后随访发现84例患者CD4T淋巴细胞中位数从基线的374.00 cell/HI上升至406.50 cell/μl (P=0.005),其中更换二线方案患者CD4+T淋巴细胞中位数从基线时的267.00 cell/μl上升至365.00 cell/μl(P=0.015),而更换后期线方案患者的CD4+T淋巴细胞中位数则无显著变化(P=0.158). 84例患者的病毒载量中位数从基线时的3.61 log10copies/ml下降至6个月后的0.00 log10copies/ml( P=0.000),更换不同方案的两组患者随访时病毒载量中位数相比基线时也都有所下降(后期一线方案:P=0.007;更换二线方案:P=0.000).随访时有13例患者体内病毒载量＞1000 copies/ml,其中5例检测到3个以上胸苷类似物耐药突变,另4例患者前后两次调杳的病毒载量无明显变化(＜3倍)且未检测到任何耐药突变.结论长时间接受治疗的艾滋病患者,在更换治疗方案6个月后机体健康状况有所改善,但合适的调整方案、及时有效的耐药检测以及随访仍不容忽视.
목적 분석하남성경환항병독치료방안적애자병환자치료상황.방법 선택84례접수국가면비일선항병독치료5년이상즉장경환치료방안적애자병환자진행기선조사,6개월후수방.조사항목주요포괄CD4+T림파세포계수、병독재량화기인형내약.결과 기선조사시84례환자균사용조기일선방안(DDI+ AZT+ NVP),일주내31례환자개시사용후기일선방안(3TC+AZT+NVP),53례환자개시사용이선방안(3TC+TDF+LPV/r).6개월후수방발현84례환자CD4T림파세포중위수종기선적374.00 cell/HI상승지406.50 cell/μl (P=0.005),기중경환이선방안환자CD4+T림파세포중위수종기선시적267.00 cell/μl상승지365.00 cell/μl(P=0.015),이경환후기선방안환자적CD4+T림파세포중위수칙무현저변화(P=0.158). 84례환자적병독재량중위수종기선시적3.61 log10copies/ml하강지6개월후적0.00 log10copies/ml( P=0.000),경환불동방안적량조환자수방시병독재량중위수상비기선시야도유소하강(후기일선방안:P=0.007;경환이선방안:P=0.000).수방시유13례환자체내병독재량＞1000 copies/ml,기중5례검측도3개이상흉감유사물내약돌변,령4례환자전후량차조묘적병독재량무명현변화(＜3배)차미검측도임하내약돌변.결론 장시간접수치료적애자병환자,재경환치료방안6개월후궤체건강상황유소개선,단합괄적조정방안、급시유효적내약검측이급수방잉불용홀시.
Objective To analyze the situation of AIDS patients who had received replaced therapy program in Henan province.Methods 84 AIDS patients had been enrolled into the national free first-line antiretroviral treatment for more than 5 years and would soon be replaced with another antiretroviral treatment program,were selected to a follow-up program to be carried out six months later Data on CD4+ tlymphocyte count,viral load and genotypic resistance were included in the study.Results The DDI + AZT + NVP treatment program was used by all the 84 patients at baseline.A replacement by 3TC + AZT + NVP (post first-line) in 31 patients and 3TC + TDF + LPV/r (second-line) in another 53 patients were taken place within a week.All the patients were followed for six months.Results showed that:all of the 84 patients appeared an amelioration of CD4 1 tlymphocyte count median from the baseline of 374.00 cell/μl to 406.50 cell/μl(P=0.005).Those patients who had changed to second-line treatment program also showed an improvement of CD4 + tlymphocyte count median from the baseline of 267.00 cell/μl to 365.00 cell/μl (P=0.015),while patients who were on the post first-line program with their CD4 + tlymphocyte count mean did not show significant change as compared to the baseline (P=0.158) data.All the 84 patients showed a decrease of virus load median from the baseline of 3.61 Iog10copies/ml to 0.00 log10 copies/ml (P=0.000).Both of the two types of patients who had been changed to different programs,had a lower virus load median in the end of the tollow-up period (for post first-line:P=0.007 ；for second-line:P=0.000).13 patients kept their viral load more than 1000 copies/ml,including 5 cases bore more than three thymidine analogue mutations (TAMs) a the end of the follow-up program.Another 4 patients had no resistance mutations detected and no significant variation of viral load (less than 3 times) in the pre-or post- surveys.Conclusion AIDS patients who had received long-term first-line antiretroviral treatment program,showed an amelioration six months after changing of the treatment program.Timely and effective testing on drug resistance as well as the strengthening of the follow-up program still seemed to be the link to those patients who were receiving first-line treatment that should not be ignored.