| 刘佳,崔为国,薛秀娟,孙国清,田随安,刘春华,程耀武,王哲.河南省84例艾滋病患者更换治疗方案6个月后的随访分析[J].中华流行病学杂志,2012,33(9):893-897 |
| 河南省84例艾滋病患者更换治疗方案6个月后的随访分析 |
| Follow-up study on 84 AIDS patients having received the replaced therapy program for six months in one county of Henan, China |
| 收稿日期:2012-03-28 出版日期:2014-09-17 |
| DOI：10.3760/cma.j.issn.0254-6450.2012.09.004 |
| 中文关键词: 艾滋病 治疗方案 随访 |
| 英文关键词: AIDS Therapy program Follow-up |
| 基金项目:河南省创新型科技人才队伍建设工程 |
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| 中文摘要: |
| 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CD4+T淋巴细胞中位数从基线的374.00 cell/μl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)，而更换后期一线方案患者的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0.00log10copies／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；更换二线力案：P=0．000)。随访时有13倒患者体内病毒载量>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例患者前后两次渊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，但合适的凋整方案、及时有效的耐药检测以及随访仍不容忽视。 |
| 英文摘要: |
| 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 Veatment for more than 5 years and would soon be replaced with another amiretroviral treatment program, were selected to a follow-uD 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-1ine)in 3l patients and 3TC + TDF + LPV/r (second-line)in another 53 patients were taken place within a week. A1l the patients were followed for six months. Results showed that: a11 ofthe 84 patients appeared an amelioration of CD4 tlymphocyte count mediall 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. A11 the 84 patients showed a decrease of virus load median from the baseline of 3.6l log10copies/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 mediani in the end of the follow-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/m1, including 5 cases bore more than three thymidine anatogue mutations(TAMs)a the end of the follow-up program. Another 4 patients had no resistance mutations detected and no significant variation of viraI load (1ess thart 3 times) in the pre-or post-surveys. Conclusion AIDS patients who had reccived 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 foIlow-up program still seemed to be the link to those patients who were receiving first-line treatment that should not be ignored |
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