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。

The clinical progression of individuals with HIV infection in Fujian and their effectiveness with anti-retroviral therapy

Through the regular follow-up examinations of CD+4T lymphocytes in peripheral blood and the viral load in plasma of individuals with HIV infection or AIDS patients in Fujian province in order to promote the implement of National AILD free-charge policy of treatment and to evaluate its effectiveness, so as to summarize experience on providing further information of standardization on clinical management of HIV infection, the HIV carriers without clinical symptoms (untreated group) and the AIDS patients not receiving high efficient antipviral therapy (treated group) were collected for regular follow up examinations including their general conditions, the determinations of levels of CD+4 T limphocytes in peripheral blood and viral loads in plasma as well as the evaluation of the clinical progression of individuals with HIV infection and the effectiveness of anti-viral treatment for AIDS patients. It was found that among the 20 cases in the untreated group, there were 7 cases showing low level of CD+4 T lymphocytes of lower than 200/μl, which had already attained the National laboratory standard requiring anti-viral therapy, although these individuals presented no any clinical symptoms. In the treated group, 46 out of 71 cases (64.8%) received the National recommended first line treatment regime, i.e. D4T+3TC+NVP, in which 82.6% (38/46) of cases showing a reduction of viral load lower down less than 1000 copies/ml and some of them even less than 50 copies/ml(under the detection limit). Meanwhile, their immune status had experienced recovery to some extend. It is apparent from the above observations that regular follow-up examinations of the symptom-less individuals infected with HIV are quite essential so as to provide them with needed medical intervention including free-charged anti-retroviral treatment to prevent the occurrence of opportunistic infection into improve their life quality. For patients with HARRT, most of them should be under control with National first-line regime of treatment, i.e. D4T+3TC+NVP, which was improved to be effective to control replication of viruses and to improve the immune status of the infected individuals to some extend.