云南省HIV／AIDS病人早期抗病毒治疗的有效性和安全性分析

目的评价云南省艾滋病病毒（HIV）感染者／艾滋病（AIDS）病人（HIV／AIDs病人）早期抗反转录病毒治疗（ART）的有效性和安全性。方法对云南省2011年8月至2012年8月期间开始ART的病人，按照基线CD4淋巴细胞（CD4细胞）计数水平分A、B两组，A组为基线CD4细胞计数〉350／±的病人（早期治疗组），B组为基线CD4细胞计数≤350／μL．的病人（延迟治疗组）。比较两组病人治疗满1年后的队列保持情况、治疗效果、治疗期间病人的不良反应和机会性感染发生等情况。结果两组9810例病人治疗满1年后，在队列保持方面，A组病人坚持治疗的比例（在治率）为88．0％（1712／1946），高于B组的84．9％（6674／7864）；死亡率A组（1．2％）低于B组（5．7％）；在治疗效果方面，两组的HIV病毒载量抑制比例差异无统计学意义（P〉0．05），两组病人中．HIV病毒载量〈C400拷贝／mL病人所占比例，分别为90．4％和91．2％；治疗6个月和12个月时，与基线CD4细胞计数相比，A组的增幅（4．32％）（治疗前后CD4细胞差值的比较）低于B组（10．27％），P〈0．01，但A组病人仍然获得比B组较高的CD4细胞平均值；在机会性感染和不良反应方面，A组的发生比例（4．3％和20．9％）均低于B组（10．3％和24．3％），P〈0．01。结论云南省HIV／AIDS病人早期治疗12个月能够获得良好的有效性和安全性，初步实现了减少HIV相关的发病率和死亡率、非艾滋病相关疾病的发病率和死亡率和改善生活质量的抗病毒治疗总体目标。

A Clinical analysis of efficacy and safety of early initiation of antiretroviral therapy among HIV infected adults in Yunnan

Objective To evaluate the efficacy and safety of early initiation of antiretroviral therapy （ART） in Yunnan Province, China. Methods This was a retrospective study enrolled 9810 patients initiated ART from August 2011 to August 2012. Patients were divided into two groups according to baseline CD4＋ T lymphocyte counts. The early treatment group （group A） had baseline CD4＋ T lymphocyte count 〉350/μL, while the delayed treatment group （group B ） had baseline CD＋ T lymphocytes count ≤ 350/μL. Treatment retention rate, HIV viral loads, CD＋ T lymphocyte counts, toxicity rates and incidence rates of opportunistic infections were analyzed. Results A mong 9810 patients treated for 12 months, the retention rates were higher in group A （88.0%） compared to group B （84.8%）. Mortality in group A was much lower than group B. The rate of virological suppression in group A and group B was 90.4% and 91.2%, respectively （P〉0.05）. Group A patients achieved higher CD4＋ T lymphocyte count median after one-year treatment. The rate of toxicity associated with AR.V use was significantly lower in group A （20. 9%） than that in group B（24.3%）. The rate of opportunistic infections and other clinical complications was significantly lower in group A （4.32%） than that in group B（10. 27% ）. Conclusions Early treatment for 12 months can achieve good efficacy and safety, which can reduce HIV-related morbidity and mortality, and improve the quality of life.