50岁及以上HIV／AIDS病人的抗病毒治疗效果

目的了解≥50岁艾滋病病毒（HIV）感染者／艾滋病（AIDS）病人（HIV／AIDS病人）的抗病毒治疗反应。方法2008年1月至2010年10月，在北京地坛医院艾滋病门诊开始抗病毒治疗时年龄≥50岁的HIV／AIDs病人作为观察组（老年组）；采用简单随机抽样法在同一时期内开始抗病毒治疗的805例年龄为18～40岁HIV／AIDS病人中，抽取168例作为对照组（青年组）。对两组病人的疾病状况、抗病毒治疗效果及不良反应进行回顾性比较分析。结果83例老年组和168例青年组的CD4＋淋巴细胞（CD4细胞）基线水平差异无统计学意义；老年组的肌酐清除率低于青年组（P〈0．01），高甘油三酯血症、高胆固醇血症、高血糖发生率老年组高于青年组（P=0．044，P=0．004，P〈0．01）。抗病毒治疗6个月后：与基线CD4细胞水平相比，两组CDt细胞均明显增加（P〈0．01，P〈0．01），增幅老年组为（112．65±107．04）个／μL，青年组为（128．39±113．85）个／μL（P〉0．05）；病毒完全抑制率老年组为82．92％，青年组为83．55％（P〉0．05）。无论是否接受基于D4T的初始治疗方案，老年组发生高血脂和高血糖的风险均高于青年组；两组接受基于AZT的初始治疗方案的病人的白细胞计数与血红蛋白变化幅度，以及两组接受基于NVP的初始治疗方案的病人的天冬氨酸转氨酶（AST）与丙氨酸转氨酶（ALT）变化状况，均无统计学意义。结论老年组与青年组相比，在接受抗病毒治疗后6个月免疫学反应和病毒学应答相同，但老年组病人易出现如高血脂和高血糖以及肌酐清除率下降等情况，因此，在≥50岁的HIV／AIDs病人的抗病毒治疗过程中应加以重视。

The effects of antiviral therapy in the HIVinfected patients aged 50 years and older

Objective To evaluate the immunology and virology effects of antiretroviral therapy in HIV / AIDS patients aged 50 years and older. Methods HIV infected patients aged 50 years and older who started antiretroviral therapy in Beijing Ditan Hospital AIDS clinic during January 2008 to October 2010 were enrolled （the older group）. And 168 cases randomly sampled from 805 HIV infected patients aged 18 to 40 years old starting antiretroviral ther apy in the same period of time were taken as a control group （youth group）. The effects and side effects of antiretro viral therapy were retrospectively analyzed. Results There was no significant difference in baseline CD4＋ T cell counts between the two groups. Creatinine clearance rate was lower in the elderly group than that in the youth group （P〈0.01）, and the incidences of hypertriglyceridemia, hypercholesterolemia and hyperglycemia were significantly higher in the elderly group than those in the youth group （P= 0. 044, P= 0. 004, P〈0.01, respectively）. Com pared with baseline CD4＋ T cellcounts, the CD4＋ T cells counts of the 2 groups were significantly increased after 6months of antiretroviral treatment （both P〈0.01）, with an increase of 112.65± 107.04 cells/ ul （elderly group） and 128.39 ± 113.85 cells / ul （youth group） （p〈 0.05）. Af ter 6 months of antiretroviral treatment, 82.92% patients was undetectable in viral load in the elderly group, and 83.55% in the youth group （P〈 0.05）. There were higher risk of high cholesterol and high blood sugar in elderly group than that in the youth group whether or not initiated with D4Tcontaining regimen. There were no significant changes in white blood cell count and hemoglobin in the patients who initially received AZTbased regimens and there were also nodifferences in AST and ALT levels in the patients who were initially received NVP based regimens between the two groups. Conclusion There are the same of immunological responses and virological responses in the elderly group comparing with the youth group after 6 months of antiretroviral therapy. But the diseases such as high cholesterol and high blood sugar and lower creatinine clearance rate which the elderly are susceptible to should be paid more at tention during antiretroviral treatment in the HIV/AIDS patients over the age of 50.