70例艾滋病患儿高效抗反转录病毒治疗的临床观察

Objective To observe the treatment response and potential issues related to antiretroviral therapy (ART) in pediatric patients with acquired immunodeficiency syndrome (AIDS) and to provide a basis for revising the treatment guideline and improving the clinical practice. Methods Children eligible for ART according to the current treatment guideline were recruited from Dehong area. Enrolled patients were provided with ART and followed up for regular clinical check and laboratory tests. Results By the end of March 2009, a total of 70 children had received ART. Among them, 60 patients were treated with regimen including zidovudine (AZT)+ lamivudine (3TC)+nevirapine (NVP). Twelve, eighteen, twenty-three and nineteen patients have tested for HIV viral load after 3 month, 6 month, 12 month and 18 month treatment, respectively. Among them, 7, 12,14 and 14 patients respectively achieved HIV viral load lower than 1000 copy/mL. Average CD4+ Tlymphocyte count increased from (317.8±288.8) × 106/L at baseline to (1037.2±1086. 1) × 106/Lafter 18 month treatment. Side effects mainly occurred within the first 3 months of treatment. Nearly 50% of children had gastrointestinal symptoms. Resistance to 3TC, NVP and efavirenz (EFV) were found in five patients who have completed 12 months of treatment. Conclusions Pediatric AIDS patients show good compliance and treatment response to ART. Most side effects happen in the first 3months of treatment and the most common side effects are gastrointestinal symptoms.     

70例艾滋病患儿高效抗反转录病毒治疗的临床观察

Objective To observe the treatment response and potential issues related to antiretroviral therapy (ART) in pediatric patients with acquired immunodeficiency syndrome (AIDS) and to provide a basis for revising the treatment guideline and improving the clinical practice. Methods Children eligible for ART according to the current treatment guideline were recruited from Dehong area. Enrolled patients were provided with ART and followed up for regular clinical check and laboratory tests. Results By the end of March 2009, a total of 70 children had received ART. Among them, 60 patients were treated with regimen including zidovudine (AZT)+ lamivudine (3TC)+nevirapine (NVP). Twelve, eighteen, twenty-three and nineteen patients have tested for HIV viral load after 3 month, 6 month, 12 month and 18 month treatment, respectively. Among them, 7, 12,14 and 14 patients respectively achieved HIV viral load lower than 1000 copy/mL. Average CD4+ Tlymphocyte count increased from (317.8±288.8) × 106/L at baseline to (1037.2±1086. 1) × 106/Lafter 18 month treatment. Side effects mainly occurred within the first 3 months of treatment. Nearly 50% of children had gastrointestinal symptoms. Resistance to 3TC, NVP and efavirenz (EFV) were found in five patients who have completed 12 months of treatment. Conclusions Pediatric AIDS patients show good compliance and treatment response to ART. Most side effects happen in the first 3months of treatment and the most common side effects are gastrointestinal symptoms.     

Clinical Observation on the Aggressive Lipid-lowering Treatment with Simvastatin on the Aged Patients with Coronary Artery Disease

Objectives To find out the efficient dose and safety of simvastatin (Zocor) on the aged patients with coronary artery disease (CAD) for aggressive lipid-lowering treatment. Methods Select 95 aged patients with CAD combined with primary hyperlipemia and give them 20mg/day of simvastatin for treatment. According to the therapeutic target of serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) regulate the dosage of simvastatin in follow-up. Observe 12-18 months. Results After treatment, the TC, LDL-C and triglycerides(TG) of the patients reduced by 40%，52% and 26% respectively, while there was no significant change in high-density lipoprotein cholesterol (HDL-C). The apolipoprotein A1 arose by 14.4%, while the apolipoprotein B lowered by 25.0%. The ratio of LDL-C to HDL-C was reduced to 1.96. In the 6^th month, the 12^th month and the 18th month, respectively, 86%, 93% and 95% of the patients took 10mg/day of simvastatin and the result was their TC≤140mg/dL(3.7mmol/L) and LDL-C≤70mg/dL(1.8mmol/L).There was no special side-effect. Multi-factor analysis indicated the age of the patients was a significant factor affecting the adjustment of the dosage of simvastatin.Conclusions The therapeutic result of simvastatin on the aged patients with CAD for aggressive lipid-lowring treatment is definite, safe and the dose is lower as well.     

Advanced gastrointestinal stromal tumor patients with complete response after treatment with imatinib mesylate

AIM: Most gastrointestinal stroma! tumors (GISTs) express constitutively activated mutant isoforms of kit kinase or platelet-derived growth factor receptor alpha (PDGFRA), which are potential therapeutic targets for imatinib mesylate (Glivec). Partial response occurred in almost two thirds of GIST patients treated with Glivec. However, complete response (CR) after Glivec therapy was sporadically reported. Here we illustrated advanced GIST patients with CR after Glivec treatment. METHODS: Between January 2001 and June 2005, 42 advanced GIST patients were treated with Glivec. Patients were administered 400 mg of Glivec in 100-mg capsules, taken orally daily with food. The response of the tumor to Glivec was evaluated after one month, three months, and every three months thereafter or whenever medical need was indicated. Each tumor of patients was investigated for mutations of kit or PDGFRA. RESULTS: The median follow-up time of the 42 ad-vanced GIST patients treated with Glivec was 16.9 months (range, 1.0-47.0 months). Overall, 3 patients had complete response CR (7.1%), 26 partial response (67.8%), 5 stationary disease (11.9%), and 3 progressive disease (11.9%). The median duration of Glivec administration for the three patients was 36 months (range, 23-36 months). The median time to CR after Glivec treatment was 20 months (range, 9-26 months). Deletion and insertion mutations of c-kit exon 11 and insertion mutation of c-kit exon 9 were found in two cases and one case, respectively. CONCLUSION: Complete response (CR) can be achieved in selected advanced GIST patients treated with Glivec. The median time to CR after Glivec treatment was 20 months. Deletion and insertion mutations of kit exon 11 and insertion mutation of kit exon 9 contribute to the genetic features in these selected cases.     

幽门螺旋杆菌根除治疗对老年人Barrett食管复发的影响

Objective To investigate the relationship between the recurrence of Barrett esophagus (BE) and Helicobacter pylori (Hp) eradication therapy, according to endoscopic follow-up outcomes in the elderly patients with BE after endoscopic argon plasma coagulation (APC). Methods A total of 201 elderly patients were enrolled to be treated with APC, including 53 patients without Hp infection (control group) and 148 cases with Hp infection (infection group), then the infection group was randomly divided into two groups: infection group A (n=74) and infection group B (n=74). After APC, all patients were given acid suppression therapy with omeprazole infusion 40 mg twice daily for 7 days, then omeprazole capsules 20 mg twice a day orally, the overall time was 2months. The patients in infection group B received Hp eradication therapy with two of the following three kinds of antibiotics for 2 weeks: amoxicillin 500 mg twice a day, clarithromycin 500 mg twice a day and tinidazole 500 mg twice a day. All patients received reexamination of endoscopy and pathology, and underwent 24-hour esophageal pH test 1, 3, 6, 12 and 24 months after treatment.Results By APC treatment for an average of 2.4 times (1-3 times), 1 month after treatment, all BE epithelium disappeared and stratified squamous epithelium was repaired completely. Reflux esophagitis (RE) and BE in some cases were found in 3 groups 3 months after therapy. The relapse incidence of RE was significantly increased at 6 months after therapy [control group: 22.6%, infection group A:12.2o%and infection group B: 17. 6%, t = 2.21, 2.17 and 2.30,P＜0. 05]. At 12 months after therapy, the relapse incidence of BE was significantly increased [control group: 22.6%, infection group A: 18.9% and infection group B: 23.0%, t=2.11, 2.19 and 2.32, P＜0. 05]. All patients presented pathological gastro-esophageal reflux (DeMeester index＞14.72) before treatment. At 1 month after therapy, all patients returned to normal DeMeester index[control group: 14.5, infection group A: 15.2 and infection group B: 12.0, t=2.09, 2.22 and 2.15, P＜0. 05]. At 6 months after treatment, DeMeester index increased (t=2.29, 2.33 and 2.14, P＜0.05). But there were no significant differences among 3 groups (P＞0. 05). Conclusions The elderly BE patients with HP infection in gastric antrum can receive APC treatment plus Hp eradication treatment, but it has no significant effect on long-term prognosis for BE patients. APC treatment can completely remove BE epithelium, long-term acid suppression therapy may delay recurrence of BE.     

Comparison between recombinant human parathyroid hormone(1-34) and elcatonin in treatment of primary osteoporosis

Objective:To evaluate the efficacy and safety of rhPTH(1-34) vs.elcatonin.Methods:Sixty palients with primary OP were randomly divided into two groups according to the ratio of 3:1.rhPTH(1-34) group(PTH group) was treated with subcutaneous injection of rhPTH(1-34) 20 μg daily for 18 months,and the elcalonin group(CT group) was treated with intramuscular injection of elcatonin 20 U weekly for 12 months.Bone mineral density(BMD) of the lumbar spine 2-4(L_(2-4))and femoral neck,serum calcium and phosphorus,urinary calcium,serum hone specific alkaline phosphatase(BSAP).and urinary c-terminal telopeptides of type Ⅰ collagen/creatinine(uCTX-Ⅰ /Cn were tested at baseline,and 6.12.and 18 months after treatment.Results:In PTH group.HMD of L_(2-4),at 6,12.and 18 months,BDM of Femoral neck at 18 month,BSAP at 6 and 12 months and uCTX- Ⅰ /Cr at 6.12 and 18 months were all significantly raised.In CT group.HMD of L_(2-4) at12 month and that of femoral neck at 12 and 18 months were significantly elevated,while HSAP was significantly decreased at 12 and 18 months,and no significant difference on CTX- Ⅰ /Cr was observed.When BMD growth and growth rate between two groups were compared.PTH group had better improvement in L_(2-4) BMD and growth rate than CT group at 6.12.and 18 months.BMD growth and growth rale of femoral neck al 12 month and its growth at 18 month in CT group were higher than in PTH group,hut there was no significant difference between two groups regarding the growth rates at 18 month.Besides,there were no significant differences regarding the rales ol adverse reactions between two groups.Conclusions:rhPTH(1—34),is safe and effective in the treatment of primary OP.It is superior to elcatonin in improving vertebral HMD at onset time,growth rate and growth range,but inferior to elcatonin at HMD of femoral neck.     

Antiviral efficacy of adefovir dipivoxil versus lamivudine in patients with chronic hepatitis B sequentially treated with lamivudine and adefovir due to lamivudine resistance

AIM： To compare the antiviral efficacy of adefovir （ADV） in lamivudine （LMV）-resistant patients with LMV treatment in nucleoside-naive patients, using serum samples collected sequentially during the course of treatment progressing from LMV to ADV.
METHODS： Forty-four patients with chronic hepatitis B （CHB） were included. The patients were initially treated with LMV and then switched to ADV when LMV resistance developed. Antiviral efficacy was assessed by measuring the following： reduction in serum HBV DNA from baseline, HBV DNA negative conversion （defined as HBV DNA being undectable by the hybridization assay）, and HBV DNA response （either HBV DNA level ≤ 10^s copies/mL or a ≥ 2 log10 reduction from baseline HBV DNA level）.
RESULTS： After two and six months of treatment, HBV DNA reduction was greater with LMV compared to ADV treatment （P = 0.021）. HBV DNA negative conversion rates were 64% and 27% after one month of LMV and ADV treatment respectively （P = 0.001）. Similarly, HBV DNA response rates were 74% and 51% after two months of LMV and ADV treatment respectively （P = 0.026）. The time taken to HBV DNA negative conversion and to HBV DNA response were both delayed in ADV treatment compared with LMV.
CONCLUSION： The antiviral efficacy of ADV in LMV-resistant patients is slower and less potent than that with LMV in nucleoside-naive patients during the early course of treatment.     

幽门螺旋杆菌根除治疗对老年人Barrett食管复发的影响

Objective To investigate the relationship between the recurrence of Barrett esophagus (BE) and Helicobacter pylori (Hp) eradication therapy, according to endoscopic follow-up outcomes in the elderly patients with BE after endoscopic argon plasma coagulation (APC). Methods A total of 201 elderly patients were enrolled to be treated with APC, including 53 patients without Hp infection (control group) and 148 cases with Hp infection (infection group), then the infection group was randomly divided into two groups: infection group A (n=74) and infection group B (n=74). After APC, all patients were given acid suppression therapy with omeprazole infusion 40 mg twice daily for 7 days, then omeprazole capsules 20 mg twice a day orally, the overall time was 2months. The patients in infection group B received Hp eradication therapy with two of the following three kinds of antibiotics for 2 weeks: amoxicillin 500 mg twice a day, clarithromycin 500 mg twice a day and tinidazole 500 mg twice a day. All patients received reexamination of endoscopy and pathology, and underwent 24-hour esophageal pH test 1, 3, 6, 12 and 24 months after treatment.Results By APC treatment for an average of 2.4 times (1-3 times), 1 month after treatment, all BE epithelium disappeared and stratified squamous epithelium was repaired completely. Reflux esophagitis (RE) and BE in some cases were found in 3 groups 3 months after therapy. The relapse incidence of RE was significantly increased at 6 months after therapy [control group: 22.6%, infection group A:12.2o%and infection group B: 17. 6%, t = 2.21, 2.17 and 2.30,P＜0. 05]. At 12 months after therapy, the relapse incidence of BE was significantly increased [control group: 22.6%, infection group A: 18.9% and infection group B: 23.0%, t=2.11, 2.19 and 2.32, P＜0. 05]. All patients presented pathological gastro-esophageal reflux (DeMeester index＞14.72) before treatment. At 1 month after therapy, all patients returned to normal DeMeester index[control group: 14.5, infection group A: 15.2 and infection group B: 12.0, t=2.09, 2.22 and 2.15, P＜0. 05]. At 6 months after treatment, DeMeester index increased (t=2.29, 2.33 and 2.14, P＜0.05). But there were no significant differences among 3 groups (P＞0. 05). Conclusions The elderly BE patients with HP infection in gastric antrum can receive APC treatment plus Hp eradication treatment, but it has no significant effect on long-term prognosis for BE patients. APC treatment can completely remove BE epithelium, long-term acid suppression therapy may delay recurrence of BE.     

Treatment of pediatric refractory Crohn’s disease with thalidomide

AIM: To assess the efficacy and tolerability of thalidomide in pediatric Crohn’s disease (CD). METHODS: Six patients with refractory CD received thalidomide at an initial dose of 2 mg/kg per day for one month, then increased to 3 mg/kg per day or decreased to 1 mg/kg per day, and again further reduced to 0.5 mg/kg per day, according to the individual patient’s response to the drug. RESULTS: Remission was achieved within three months. Dramatic clinical improvement was demonstrated after thalidomide treatment...     

Effects of XUEZHIKANG on Oxidized Low Density Lipoprotein,C-Reactive Protein, Fibrinogen in Unstable Angina Pectoris Patients

Objectives To study the effects of XUEZHIKANG on lipid modulating and the level of oxidized low density lipoprotein(OX -LDL),C-reactive protein(CRP), fibrinogen(FIB) in serum.Methods XUEZHIKANG was given to patients with unstable angina pectoris and hyperlipidemia at a dose of 0. 6 gram bid for 2 months and with half-dose for another 2 months. Vitamin E was given to unstable angina pectoris patients with normal lipid at the dose of 0. 1 gram bid for 4 months respectively.Then compared the level of lipid and OX - LDfL, CRP,FIB in serum at beginning, first- month and second-month. Results XUEZHIKANG can reduce the serum level of total cholesterol, low density lipoprotein in 1 month, and gained better effect in 2 months. It can also reduce triglyceride and increase high density lipoprotein in 2 months. Compared with vitamin EXUEZHIKANG can reduce the level of OX- LDL,CRP, FIB significantly after treatment for 2 months.Conclusions XUEZHIKANG has significant effect in lipid modulating , and it can also inhibit the development of inflammation in coronary plaque.     

云南省德宏州1039例成人艾滋病患者抗病毒治疗效果评价

目的 评价德宏州成人HIV感染者、AIDS患者接受国家免费高效抗反转录病毒治疗(HAART)的效果.方法 回顾性分析德宏州5个县市2004年7月1日至2008年6月30 H期间规范HAART的1039例HIV感染者、AIDS患者的临床资料,评估治疗不同时间段患者的病毒学及免疫学应答情况.数据行卡方检验或F检验.结果 1039例HIV感染者、AIDS患者中,男611例,女428例,平均年龄(37.0±9.9)岁,平均治疗(22.41±12.69)个月.其中781例患者病毒得到完全抑制,HIV载量＜50拷贝/mL,占75.17%.接受HAART 6～12、13～24、25～36个和≥37个月时,病毒完全抑制率分别为76.95%、76.49%、70.65%、77.73%,不同治疗时间病毒完全抑制率比较,差异无统计学意义(x2=8.646,P=0.194).患者基线CD4+T淋巴细胞计数为(164.93±118.05)×106/L,接受HAART 6～12、13～24、25～36和≥37个月时分别为(330.85±201.73)×106/L、(356.24±205.49)×106/L、(434.53±250.65)×106/L和(396.31±202.62)×106/L,其中治疗时间为25～36个月和≥37个月时CD4+T淋巴细胞计数比较,差异无统计学意义;其余各治疗时间段间CD4+T淋巴细胞计数比较,差异有统计学意义(F=19.423,P＜0.01).随访1020例患者CD4+T淋巴细胞情况,其中927例出现免疫学应答,占90.88%.病毒学应答和免疫学应答均成功者717例,占70.29%,均失败者40例,占3.92%.结论 云南省德宏地区HIV感染者、AIDS患者对HAART有较好的病毒学及免疫学应答.     

基于国产司他夫定和齐多夫定的抗HIV治疗优化方案的探索

目的探索基于国产仿制高效抗反转录病毒治疗药物司他夫定（D4T）胶囊、齐多夫定（AZT）片为初始治疗方案的优化治疗策略,以达到良好的治疗效果,降低药物不良反应发生率,合理地使用国产仿制药物,最终能长期可持续的治疗。方法选择75例无机会性感染的、CD4＋T淋巴细胞〈350×106/L的、完成96周随访的艾滋病病毒（HIV）感染者/艾滋病（AIDS）患者,随机分为A组27例,服用D4T＋拉米夫定（3TC）＋奈韦拉平（NVP）/依非韦伦（EFV））;B组27例,服用AZT＋3TC＋NVP/EFV;C组21例,前24周服用D4T＋3TC＋NVP/EFV,24周后服用AZT＋3TC＋NVP/EFV。观察3组的治疗效果及D4T、AZT的不良反应发生规律。结果治疗96周前后,A组患者的CD4＋T淋巴细胞计数中位数分别是219（15～332）×106/L和420（203～635）×106/L,B组分别为224（28～332）×106/L和366（178～724）×106/L,C组分别为153（19～350）×106/L和411（95～728）×106/L。A、B、C 3组患者血浆HIV RNA〈40拷贝/mL的比率分别为92.6%、96.3%、100%。A组D4T的不良反应发生率高达81.5%,主要发生在治疗36周之后;B组AZT的不良反应发生率高达48.2%,主要发生在治疗前12周内;C组在服用D4T24周后改服AZT,D4T的不良反应发生率为0,AZT的相关不良反应发生率为9.5%,明显低于A组（P〈0.05）和B组（P〈0.05）。结论 D4T治疗24周后更换为AZT的优化方案与长期服用D4T或AZT方案,均能获得满意的治疗效果,但不良反应发生概率优化方案明显低于长期D4T或AZT方案治疗者,可做为目前国产仿制药物初始治疗的优化方案。     

抗反转录病毒治疗儿童艾滋病效果评价

目的 评估抗反转录病毒疗法(ART)治疗儿童AIDS的效果.方法 选择2004年3月至2008年12月符合世界卫生组织规定的治疗条件的22例HIV感染儿童进行ART,治疗方案为2种核苷类反转录酶抑制剂(NRTI)和1种非核苷类反转录酶抑制剂(NNRTI)的联合应用.治疗前、治疗后1～36个月定期检测身高、体质量、血常规、外周血CD4+T淋巴细胞数量、CD8+T淋巴细胞数量和血浆病毒载量(VL),并对两组数据进行t检验.结果 19例获得临床进步,治疗后6个月身高增加倍数为1.04±0.02(t=2.356,P＜0.05),体质量增加倍数为1.14±0.01(t=2.567,P＜0.05),机会性感染率下降(72.7%比27.3%);3例临床治疗失败,其身高、体质量增加迟缓,甚至下降,其中2例死亡.19例获临床进步的儿童中,VL在治疗后3个月均降至2.7 lg拷贝/mL以下;CD4+T淋巴细胞数从(145.50±86.72)×106/L升至治疗后3个月(262.80± 213.62)×106/L(t=2.668,P＜0.05);CD4+/CD8+T淋巴细胞比值为0.14±0.11比0.23±0.21(t=2.607,P＜0.05),其中CD4+/CD8+T淋巴细胞比值在治疗后9个月上升至峰值,而CD4+T淋巴细胞数绝对值在12个月达到峰值,随后至36个月均维持在较高水平;外周血WBC和RBC总数均下降,Hb从(107.29±13.74)g/L升至(112.15±11.20)g/L(t=2.325,P＜0.05).结论 现阶段在我国试点开展的ART治疗方案能够抑制儿童AIDS体内病毒复制,是机体免疫重建和临床症状改善的有效方案.     

Experience with the use of a first-line regimen of stavudine, lamivudine and nevirapine in patients in the TREAT Asia HIV Observational Database

BACKGROUND: The antiretroviral treatment (ART) combination of stavudine, lamivudine and nevirapine (d4T/3TC/NVP) is the most frequently used initial regimen in many Asian countries. There are few data on the outcome of this treatment in clinic cohorts in this region. METHODS: We selected patients from the TREAT Asia HIV Observational Database (TAHOD) who started their first ART regimen with d4T/3TC/NVP. Treatment change was defined as cessation of therapy or the addition or change of one or more drugs. Clinical failure was defined as diagnosis with an AIDS-defining illness, or death while on d4T/3TC/NVP treatment. RESULTS: The rate of treatment change among TAHOD patients starting d4T/3TC/NVP as their first antiretroviral treatment was 22.3 per 100 person-years, with lower baseline haemoglobin (i.e. anaemia) associated with slower rate of treatment change. The rate of clinical failure while on d4T/3TC/NVP treatment was 7.3 per 100 person-years, with baseline CD4 cell count significantly associated with clinical failure. After d4T/3TC/NVP was stopped, nearly 40% of patients did not restart any treatment and, of those who changed to other treatment, the majority changed to zidovudine (ZDV)/3TC/NVP and less than 3% of patients changed to a protease inhibitor (PI)-containing regimen. The rates of disease progression on the second-line regimen were similar to those on the first-line regimen. CONCLUSION: These real-life data provide an insight into clinical practice in Asia and the Pacific region. d4T/3TC/NVP is maintained longer than other first-line regimens and change is mainly as a result of adverse effects rather than clinical failure. There is a need to develop affordable second-line antiretroviral treatment options for patients with HIV infection in developing countries.     

Standard-dose efavirenz vs. standard-dose nevirapine in antiretroviral regimens among HIV-1 and tuberculosis co-infected patients who received rifampicin

Background

There is limited comparative data between efavirenz (EFV) 600 mg/day and nevirapine (NVP) 400 mg/day‐based antiretroviral therapy (ART) among HIV‐1 patients with tuberculosis (TB) and receiving rifampicin.

Methods

A retrospective cohort study was conducted in all ART‐naïve patients who were receiving rifampicin between January 2002 and December 2005.

Results

Of 188 patients, 77 and 111 patients were initiated on EFV‐based ART (EFV group) and NVP‐based ART (NVP group), respectively. Overall, median [interquartile range (IQR)] CD4 count was 36 (15–77) cells/μL and median (IQR) viral load was 5.6 (5.2–5.9) HIV‐1 RNA log copies/mL. At 48 weeks, 77.9% (60/77) in the EFV group and 67.6% (75/111) in the NVP group achieved HIV‐1 RNA <50 copies/mL (P=0.140, odds ratio =0.590, 95% confidence interval=0.302–1.153). At 24 and 48 weeks, respective median CD4 counts were 174 and 254 cells/μL in the EFV group and 156 and 218 cells/μL in the NVP group (P>0.05). By binary logistic regression, treatment group was not associated with HIV‐1 RNA <50 copies/mL (P>0.05). No patient in the EFV group and eight (7.2%) patients in the NVP group discontinued ART because of adverse reactions (P=0.084).

Conclusions

For HIV–TB co‐infected patients who receive rifampicin, efficacy of 600 mg EFV‐based and 400 mg NVP‐based ART may be similar, although adverse events tend to be higher in NVP‐based ART.     

福建省HIV感染者临床进展和抗病毒治疗的效果观察

目的通过检测我省部分HIV感染者/艾滋病病人外周血CD4+T淋巴细胞和血浆HIV病毒载量水平(Viral Load,VL),促进落实国家免费抗病毒治疗政策,为指导抗病毒治疗的实施和规范化管理提供依据。方法定期随访未经治疗无临床症状HIV病毒携带着者(未治疗组)和接受高效抗病毒治疗的艾滋病病人(治疗组),收集其一般情况、采集其外周静脉抗凝全血进行CD4+T淋巴细胞和病毒载量水平测定,评价感染者病情进展以及艾滋病病例的抗病毒治疗效果。结果未治疗组20例,虽然均无任何临床不适,但是其中已有7例CD4+T淋巴细胞水平低于200个/μl,VL超过30000cp/ml符合国家启动抗病毒治疗的实验室指标,急需医疗干预。治疗组71例,64.8%(46/71)接受的是国家一线治疗方案(D4T+3TC+NVP)。治疗后,82.6%(38/46)收到预期的治疗效果,病毒载量低于1000拷贝/ml,其中有些甚至低于检测线以下(<50拷贝/ml)。免疫系统状态也分别得到不同程度的恢复。结论1)应加强对无症状HIV感染者的定期随访,适时落实免费抗病毒治疗,以减少机会性感染的发生,提高感染者的生活质量。2)目前国家实施的免费抗病毒一线方案(D4T+3TC+NVP)能有效控制病毒的复制,也使感染个体的免疫功能得以一定程度的恢复。     

高效抗逆转录病毒治疗对74例艾滋病初治患者三年疗效观察

目的 观察我国AIDS初治患者接受高效抗逆转录病毒治疗(HAART)的疗效,为规范HAART提供依据.方法 对74例初治AIDS患者给予HAART并进行定期随访,分析随访3年来的疗效、毒副反应及耐药情况.结果 74例患者男46例,女28例,平均年龄42岁.治疗前HIV病毒载量为(2.2±2.0)×105拷贝/ml,CD4+T淋巴细胞计数(62±71)个/μl;接受HAART后3、6、12、18、24、30、36个月,HIV病毒载量小于50拷贝/ml的百分率分别为:71.6%、83.8%、75.7%、77.0%、82.4%、81.1%、79.7%;CD4+T淋巴细胞计数分别为:(167±105)、(177±129)、(238±137)、(290±158)、(304±191)、(331±175)、(352±202)个/μl;各观察时段CD4+T淋巴细胞计数增加幅度不同,以0～3个月时明显,显著高于其余时段的改变(P＜0.01).74例患者中发生肝功能损害52例(70.3%),血脂升高52例(70.3%),骨髓造血功能抑制33例(44.6%),外周神经炎32例(43.2%),外周脂肪萎缩26例(35.1%).9例患者出现临床耐药并检测到相关耐药基因位点突变.结论 我国AIDS初治患者接受HAART后病毒学及免疫学应答效果好,临床耐药较低,但毒副反应较大.

Abstract：

Objective To evaluate the therapeutic effect of highly active anti-retroviral therapy (HAART) in treatment-na(i)ve Chinese patients with AIDS, to provide evidences for standardizing HAART.Methods Seventy-four treatment-naive AIDS patients were initiated with HAART and followed up regularly for 3 years. The clinical and laboratory data, side effects and drug resistance were observed and analyzed during the follow-up period. Results Of the 74 patients, 46 were males and 28 were females, with the average age being 42 years. The mean HIV viral load was ( 2. 2 ± 2.0 ) × 105 copies/ml and the baseline mean CD4+ T lymphocyte count was (62 ± 71 )cells/μl before treatment. After treatment for 3, 6, 12, 18,24, 30 and 36 months, the percentage of undetectable HIV viral road (less than 50 copies/ml ) was 71.6%, 83.8%, 75.7%, 77.0%, 82.4%, 81.1% and 79.7% respectively, and CD4+T lymphocyte count ascended to ( 167 ± 105), ( 177 ± 129), (238 ± 137), (290 ± 158), (304 ± 191 ), (331 ± 175) and ( 352 ± 202 ) cells/μl. The increase in amplitude of CD4+ T lymphocyte count in different periods examined was different, with the period of 0-3 months post-treatment demonstrating the most obvious augmentation ( P ＜ 0. 01 ) . The most common adverse reactions were liver function injury ( 52/74,70. 3% ), hyperlipemia (52/74, 70. 3%), hematopoietic inhibition of the bone marrow (33/74, 44. 6% ),peripheral neuritis (32/74, 43.2% ) and lipoatrophy (26/74, 35. 1%). Clinical drug resistance were found in nine patients and HIV gene mutations were detected in these patients. Conclusions Chinese treatment-naive AIDS patients have achieved good virological and immunological response to generic-drugpredominant HAART regimes with low drug resistance, but relatively more side effects.     

AIDS病人接受奈韦拉平治疗的相关肝毒性

目的了解艾滋病（AIDS）病人接受奈韦拉平（NVP）治疗的相关肝毒性。方法采用回顾性分析的方法,对2005-2011年在布拖县接受抗病毒治疗的AIDS病人,出现3～4级肝毒性的临床资料进行总结和分析。结果接受抗病毒治疗的826例病人中,治疗6个月内出现3～4级肝毒性的22例（2.7%）。基线检查：22例中,丙型肝炎病毒（HCV）抗体阳性16例（72.7%）,乙型肝炎病毒表面抗原（HBsAg）阳性12例（54.5%）,抗-HCV和HBsAg均阳性者8例（36.4%）;抗-HCV和HBsAg均阴性者2例（9.1%）,分别与抗-HCV阳性、HBsAg阳性者比较差异均有统计学意义（P〈0.05）。丙氨酸氨基转移酶（ALT）平均为（48.71±29.93）U/L,总胆红素（TBIL）平均为（14.34±8.24）μmol/L。全部使用含有NVP的治疗方案,治疗6个月内出现ALT和TBIL升高,与治疗前基线相比分别平均升高（281.67±213.99）U/L和（88.89±189.42）μmol/L,差异有统计学意义（P〈0.05）。经保肝及用依非韦伦（EFV）或克力芝（LPV/r）替换NVP后,19例（86.4%）治愈,3例（13.6%）好转出院,其中1例（4.5%）出院3个月后死亡。结论艾滋病毒（HIV）合并HCV或/和HBV感染,是NVP发生严重肝毒性的重要危险因素,尤其是合并HCV感染者危险性大,应避免应用。     

Maternal 12-month response to antiretroviral therapy following prevention of mother-to-child transmission of HIV type 1, Ivory Coast, 2003-2006.

OBJECTIVE: Our aim was to study the response to antiretroviral treatment among women exposed to single-dose nevirapine (NVP) and/or short-course zidovudine (ZDV; with or without lamivudine [3TC]) for the prevention of mother-to-child transmission of human immunodeficiency virus (HIV) infection. METHODS: All HIV type 1-infected women who initiated antiretroviral treatment with stavudine or ZDV, 3TC, and NVP or efavirenz were eligible for the MTCT-Plus program in Abidjan, Ivory Coast. Exposed women had received either single-dose NVP alone or short-course ZDV (with or without 3TC) plus single-dose NVP during previous pregnancy. Genotypic resistance testing was performed at week 4 after delivery. Virologic failure was defined as a plasma HIV RNA level >500 copies/mL 12 months after initiation of antiretroviral treatment. RESULTS: Among 247 women who received antiretroviral treatment, 109 (44%) were unexposed; 81 had received short-course ZDV with 3TC, as well as single-dose NVP; 5 had received short-course ZDV plus 3TC; 50 had received short-course ZDV plus single-dose NVP; and 2 had received single-dose NVP alone. No ZDV mutation was detected in the 115 women whose specimens were available for genotypic testing; 11 (15.1%) of 73 women with 3TC exposure who were tested after delivery had 3TC resistance mutations. Three (4.3%) of 69 women exposed to short-course ZDV and 3TC plus single-dose NVP and 16 (38.1%) of 42 women exposed to short-course ZDV plus single-dose NVP had NVP resistance mutations. Antiretroviral treatment was initiated a median of 21 months after the intervention to prevent mother-to-child HIV transmission (median CD4(+) T lymphocyte count, 188 cells/mm(3)). Month 12 virologic failure was identified in 42 (19.2%) of 219 women for whom data were available, and multivariate analysis revealed that it was associated with poor adherence to treatment (adjusted odds ratio [aOR], 12.7; 95% confidence interval [CI], 3.0-53.9), postpartum 3TC resistance mutations (aOR, 6.9; 95% CI, 1.1-42.9), and a baseline CD4(+) T lymphocyte count <200 cells/mm(3) (aOR, 0.3; 95% CI, 0.2-0.8). NVP resistance was not associated with virological failure (aOR, 1.8; 95% CI, 0.5-6.5). CONCLUSIONS: Our study found that poor adherence and 3TC resistance acquired after the intervention to prevent mother-to-child transmission of HIV infection were associated with virologic failure in women who initiated antiretroviral treatment.     

3TC＋TDF＋LPV／r方案治疗免疫重建不良AIDS病人的临床观察

目的观察核苷类反转录酶抑制剂（NRTI）＋蛋白酶抑制剂（PI）方案,对免疫重建不良的艾滋病（AIDs）病人免疫功能的影响。方法接受一线抗病毒治疗1年以上、病毒载量低于检测下限（〈50拷贝／mL）且免疫学失败的病人,改用NRTI＋PI方案,即用拉米夫定（3TC）、替诺福韦酯（TDF）＋洛匹那韦／利托那韦（LPV／r）治疗12个月,检测治疗期间病人CD＋T淋巴细胞（CD4细胞）数的变化。结果收集的16例病毒载量〈50拷贝／mL且免疫学失败的病人,在接受治疗3、6和12个月后,病人CD。细胞数分别上升至（195±5．63）个／μL（213±4．68）个／μL和（270±4．36）个／μL,显著高于基线（换药时）CD4细胞水平（131±3．65个／μL）（P〈0．01）。结论3TC＋TDF＋LPV／r方案可以促进病毒载量低而免疫功能低下的病人的免疫重建。