无症状HIV感染者早期启动抗逆转录病毒治疗的疗效和安全性评价

发布时间：2018-12-28 07:31

【摘要】：目的系统评价早期抗逆转录病毒治疗(antiretroviral therapy,ART)对无症状HIV感染者的有效性和安全性,探讨无症状HIV感染者ART的最佳启动时机。方法计算机检索Pub Med、EMbase、The Cochrane Library(2016年4期)、CBM、CNKI、VIP及Wan Fang Data数据库,全面搜集有关无症状HIV感染者ART最佳启动时机或早期治疗的随机对照试验(RCT)。检索时限均从1996年1月至2016年4月。由2位研究员按纳入与排除标准独立筛选文献、提取资料并评价偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果共纳入4个RCT,8 751例患者。Meta分析结果显示,在CD 4+T淋巴细胞计数(CD 4计数)≥350个/μL时,包括CD 4计数≥500个/μL时启动ART,相对于延迟至CD 4计数350个/μL时启动ART治疗,更能给HIV感染者带来明显获益:1在CD 4计数≥350个/μL时启动ART,患者AIDS病情进展的风险显著下降[RR=0.49,95%CI(0.38,0.64),P0.001];若在CD 4计数≥500个/μL时就启动治疗,AIDS病情进展风险还可进一步下降[RR=0.38,95%CI(0.24,0.59),P0.001];2在CD 4计数≥350个/μL时启动ART,患者发生严重非AIDS相关事件的风险显著下降[RR=0.58,95%CI(0.40,0.83),P=0.003];3在CD 4计数≥350或500个/μL时启动ART,相较于延迟启动治疗的患者,两组全因死亡率[RR=0.70,95%CI(0.48,1.02),P=0.06]以及随访期间发生严重不良反应事件的风险[RR=0.67,95%CI(0.38,1.20),P=0.18]的差异并无统计学意义。结论本研究结果支持对所有CD 4计数在350~500个/μL的无症状HIV感染者启动ART。针对CD 4计数在500个/μL以上的患者,亦建议启动治疗。随着治疗覆盖面的扩大和治疗时间的延长,应进一步加强患者的服药依从性教育和随访管理,控制耐药毒株在人群中的流行,预防长期治疗带来的远期不良反应。
[Abstract]:Objective to evaluate the efficacy and safety of early antiretroviral therapy (antiretroviral therapy,ART) in asymptomatic HIV infected patients, and to explore the best start-up time for asymptomatic HIV infected patients with ART. Methods Pub Med,EMbase,The Cochrane Library (2016 issue 4), CBM,CNKI,VIP and Wan Fang Data databases were searched by computer to collect the best start time or early treatment of ART in asymptomatic HIV infected patients. (RCT). Was used as a randomized controlled trial. The time limit for retrieval is from January 1996 to April 2016. According to the inclusion and exclusion criteria, two researchers independently sifted the literature, extracted the data and evaluated the bias risk, and then analyzed the data with Rev Man 5.3 software. Results four patients with RCT,8 were included. Meta analysis showed that when CD 4 T lymphocyte count (CD 4 count) 鈮，

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