CAJ | 학술논문

目的了解HCV/HIV共感染者在艾滋病一线抗病毒治疗病毒学失败后更换二线治疗方案一年内的效果和耐药情况.方法招募2012年5-10月间河南省新蔡、确山和尉氏3县中HIV/HCV抗体阳性且使用一线艾滋病抗病毒治疗方案一年后病毒载量未得到抑制的患者.患者更换艾滋病二线治疗方案后6个月和12个月时进行随访和CD4+T淋巴细胞计数、HIV病毒载量和HIV耐药性检测.结果符合条件的81例HIV/HCV共感染者的CD4+T淋巴细胞中位数在更换二线药物6个月、12个月后出现回升;基线、6个月和12个月的CD4+T淋巴细胞中位数分别为266cells/μl、275 cells/μl和299 cells/μl(x2=8.214,P=0.009);HIV病毒载量得到抑制的患者比例分别上升到6个月、12个月的46.84％、50.00％.HIV耐药发生率显著下降,基线、6个月和12个月的耐药发生率分别为66.67％、26.58％和27.63％(x2=29.362,P=0.000);同时NRTI和NNRTI耐药的发生率均下降,基线、6个月和12个月的发生率分别为51.85％、18.99％和17.11％(x2=14.230,P=0.005).81例患者在基线时对NRTI中3TC、ABC和FTC的耐药发生率都在50％以上,对AZT、D4T和DDI的耐药发生率在41％～44％之间,对TDF的耐药发生率为33.33％,6个月和12个月后下降到12％～ 18％.患者基线时对NNRTI中NVP和EFV的耐药率都达到65.43％,而在更换二线药物6个月和12个月后都下降到24％～ 27％.结论发生一线艾滋病抗病毒治疗病毒学失败的HIV/HCV共感染者在更换二线治疗方案6个月后状况得到了改善,但是在12个月后治疗效果改善有限.
목적 료해HCV/HIV공감염자재애자병일선항병독치료병독학실패후경환이선치료방안일년내적효과화내약정황.방법 초모2012년5-10월간하남성신채、학산화위씨3현중HIV/HCV항체양성차사용일선애자병항병독치료방안일년후병독재량미득도억제적환자.환자경환애자병이선치료방안후6개월화12개월시진행수방화CD4+T림파세포계수、HIV병독재량화HIV내약성검측.결과 부합조건적81례HIV/HCV공감염자적CD4+T림파세포중위수재경환이선약물6개월、12개월후출현회승;기선、6개월화12개월적CD4+T림파세포중위수분별위266cells/μl、275 cells/μl화299 cells/μl(x2=8.214,P=0.009);HIV병독재량득도억제적환자비례분별상승도6개월、12개월적46.84％、50.00％.HIV내약발생솔현저하강,기선、6개월화12개월적내약발생솔분별위66.67％、26.58％화27.63％(x2=29.362,P=0.000);동시NRTI화NNRTI내약적발생솔균하강,기선、6개월화12개월적발생솔분별위51.85％、18.99％화17.11％(x2=14.230,P=0.005).81례환자재기선시대NRTI중3TC、ABC화FTC적내약발생솔도재50％이상,대AZT、D4T화DDI적내약발생솔재41％～44％지간,대TDF적내약발생솔위33.33％,6개월화12개월후하강도12％～ 18％.환자기선시대NNRTI중NVP화EFV적내약솔도체도65.43％,이재경환이선약물6개월화12개월후도하강도24％～ 27％.결론 발생일선애자병항병독치료병독학실패적HIV/HCV공감염자재경환이선치료방안6개월후상황득도료개선,단시재12개월후치료효과개선유한.
Objective To understand the one-year effect of HCV/HIV co-infected patients who had received AIDS second-line antiretroviral treatment after failure virologically,on the first-line therapy.Methods HCV and HIV antibody positive patients who had experienced virological failure but received at least one-year AIDS first-line treatment,were recruited from May to October 2012 in Xincai,Queshan and Weishi of Henan province.6-months and 12-months follow-up programs were carried out after the regimen had been changed to AIDS second-line antiretroviral treatment,CD4 +T lymphocyte count,HIV-1 virus load and HIV-1 drug resistance were performed.Results Eighty-one cases of eligible patients were selected and followed by an amelioration of CD4 median at 6-month and 12-month follow-up period.Data showed that the baseline,6-months and 12-months CD4 medians were 266 cells/μl,275 cells/μl and 299 cells/μl (x2=8.214,P =0.009).The ratio of HIV virus load suppression patients at 6-months and 12-months follow-up increased to 46.84％ and 50.00％,respectively.Frequencies of HIV drug resistance also decreased at the baseline,6-months and 12-months,with ratios as 66.67％,26.58％ and 27.63％(x2=29.362,P=0.000),respectively.Ratios of patients that holding NRTI and NNRTI drug resistance appeared coinstantaneous decrease at the baseline,6-months and 12-months,as 51.85％,18.99％ and 17.11％(x2=14.230,P=0.005).At the baseline,the ratios of patients resisted to 3TC,ABC and FTC were all more than 50％,with AZT,D4T and DDI between 41％-44％ while TDF appeared as 33.33％,then all of them declined to 12％-18％ at the 6-month and 12-month follow-up periods.65.43％ of the patients resisted to both NVP and EFV but declined to 24％-27％ at 6 months and 12 months.Conclusion HCV/HIV co-infected patients experienced virological failure of AIDS first-line therapy were ameliorated after changing to use second-line antiretroviral treatment for 6-months,but did not show constant positive effect at the 12-month end point.