≥50岁HIV感染病人不同初始治疗方案的疗效分析

发布时间：2018-02-25 17:46

本文关键词： 艾滋病病毒老年感染者抗病毒治疗　出处：《中国艾滋病性病》2017年09期 　论文类型：期刊论文

【摘要】：目的分析广西≥50岁艾滋病病毒(HIV)感染病人采用不同初始治疗方案的疗效,为老年HIV感染病人的抗病毒治疗(ART)提供临床经验。方法将1 893例老年HIV感染病人分为3组,每组631例,分别用含洛匹那韦/利多那韦(LPV/r)、依非韦伦(EFV)、奈韦拉平(NVP)的标准三联方案进行初始治疗,分析比较3组的病毒学、免疫学效果。结果三组病人的基线特征中,性别差异有统计学意义(P=0.015),其他指标均无差异。12个月时,LPV/r组、EFV组、NVP组的病毒抑制率分别为82.17%、87.24%、80.04%,EFV组的病毒抑制率明显高于NVP和LPV/r组(P=0.006),是NVP组的1.71倍[95%可信区间(CI):1.22~2.38],LPV/r组的1.48倍(95%CI:1.06~2.08)。进一步分析发现,12个月时,LPV/r组与EFV组在病毒载量(VL)400拷贝/mL及VL1 000拷贝/mL水平的抑制率无差异(P0.05),并且均高于NVP组(P0.05)。随后LPV/r组、EFV组、NVP组的病毒抑制率在24个月时,分别为87.26%、86.06%、83.46%,在36个月时为93.30%、91.62%、90.03%,在48个月时为88.00%、90.59%、93.60%,3组间差异无统计学意义(P0.05)。免疫学方面,治疗后6~42个月,3组间的CD4~+T淋巴细胞计数差异有统计学意义(P0.05),LPV/r组显著高于NVP组和EFV组,而第48个月,3组间差异虽然无统计学意义(P=0.084),但LPV/r组的均值高于EFV和NVP组。结论含LPV/r、EFV、NVP的不同初治方案治疗老年HIV感染病人均获良好的疗效。含LPV/r的初治方案虽然在1年时的病毒抑制率低于EFV方案,但4年的长期病毒抑制率并无差别,在免疫学效果上的优势突出。
[Abstract]:Objective to analyze the efficacy of different initial treatment regimen in patients with HIV infection over 50 years old in Guangxi, and to provide clinical experience for antiviral therapy in elderly patients with HIV infection. Methods 1 893 elderly patients with HIV infection were divided into 3 groups. A total of 631 patients in each group were treated with a standard triple regimen containing lopinavir / ridonavir, EFVN, nevirapine NVP, respectively. The virological and immunological effects of the three groups were analyzed and compared. Results in the baseline features of the three groups, At 12 months, the virus inhibition rate of NVP / R group was 82.17 and 87.24 ~ 80.04% respectively, which was significantly higher than that of NVP and LPV/r group P0.006, and 1.71 times that of NVP group [95% CI: 1.22 / 2.38] LPV-R group. Further analysis showed that there was no difference in the inhibition rates of virus load between LPV-r group and EFV group at the levels of 400 copies / mL and #number0# copies / mL of VL1 at 12 months, and both of them were higher than those of NVP group (P0.05). Subsequently, the inhibition rate of virus in LPV/r group was at 24 months. There was no significant difference in CD4T lymphocyte counts between the three groups at 36 months after treatment and 88.00 at 48 months (P 0.05). In immunology, the number of CD4T lymphocytes in the three groups was significantly higher than that in the NVP group and the EFV group at 6 ~ 42 months after treatment, and there was a significant difference in the number of CD4T lymphocytes between the three groups after treatment (P < 0.05), and there was no significant difference in the number of CD4T lymphocytes between the three groups (P < 0.01 or P < 0.05), and the number of CD4T lymphocytes in the three groups was significantly higher than that in the NVP group and the EFV group (P < 0.05), which was significantly higher than that in the NVP group and the EFV group (P < 0.05). Although there was no significant difference among the three groups in the 48th month, the mean value of LPV/r group was higher than that of EFV and NVP group. Conclusion the different initial treatment regimens with LPV-r-EFVV LPV/r have good curative effect on the elderly patients with HIV infection. Although the initial treatment regimen with LPV/r is better than that of EFV and NVP groups, the initial treatment regimen with LPV/r can be used in the treatment of elderly patients with HIV infection. The virus inhibition rate at 1 year was lower than that of EFV regimen. But 4 years long-term virus inhibition rate has no difference, in immunological effect superiority is outstanding.
【作者单位】：广西壮族自治区龙潭医院;
【基金】：国家十二五科技重大专项:(2012ZX10004910-006-002)~~
【分类号】：R512.91

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