湖南省6558例HIV/AIDS病人HAART疗效及不良反应分析

目的了解湖南省开展艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（简称HIV/AIDS病人）高效抗反转录病毒治疗（HAART）的疗效、不良反应及耐药等情况。方法采用回顾性研究,对湖南省2003年9月至2012年12月间接受HAART的病例进行分析。结果共有6558例HIV/AIDS病人接受了HAART：1）CD＋4T淋巴细胞（简称CD4细胞）计数随治疗时间的延长明显升高,按照基线CD4细胞水平划分为≤99个/μL、100~199个/μL、200~350个/μL三组,然后做两两比较,差异有统计学意义（P〈0.01）。2）在治疗后7-12个月,64%的病人体内病毒复制得到了完全抑制,病毒载量检测值〈50拷贝/mL;在治疗后7-12个月,病毒载量〈50拷贝/mL的比例及病毒载量常用对数值lgVL变化幅度最大,12个月以后下降趋势减缓,约3年后进入平台期。3）服药后较常见的不良反应是胃口改变、恶心呕吐、皮疹及疲倦等,因不良反应更换治疗方案的病例占总换药病例的70.1%（1719/2451）,因不良反应停药占总停药病例的33.6%（178/529）。4）最近一次病毒载量检测〈50拷贝/mL的2739例病人中,连续2次CD4细胞计数较基线水平增幅〈20%,或治疗一年以上未达200个/μL的共375例,免疫无应答比例13.7%。5）2011及2012连续两年耐药监测显示,总耐药率为2.6%,处于较低水平。结论湖南省艾滋病HAART在免疫学和病毒学方面均取得了较好的疗效,需进一步加强不良反应、免疫无应答及耐药情况的监测和处理。

An analysis on therapeutic effects and side effects of highly active antiretroviral therapy among 6558 HIV/AIDS patients in Hunan Province

Objective To understand therapeutic effects, side effects and drug resistance during the highly active antiretroviral therapy （HAART） in Hunan. Methods A retrospective cohort analysis was conducted on all the HIV/AIDS patients who started HAART during 2003 to 2012. Results 1） A total of 6 558 HIV/AIDS patients re- ceived HAART during the study period. On the whole, CD4＋T cell counts increased remarkably compared with those of baseline. All cases were divided into three groups （≤99,100--199 and 200-350 cells/μL） by baseline CD4 ＋T cell counts and comparisons between groups were significant （P（0.01）. 2） About 64% of the cases got complete viral control within 7 to 12 months after HAART. Proportion of patients with viral load （VL） （50 copies/mL and IgVL showed great changes in the first 7-12 months. The trend of decline slowed after 12 months and plateau usually came after 3 years. 3） Most common side effects after starting HAART were appetite changing, nausea, vomiting, rash and fatigue. Of all cases changing regimen, 70.1% were because of side effects and 33.6% of drug withdrawal were because of side effects. 4） Of the 2 739 patients with VL （50copies/mL, 13.7% were im- munological non responders （INRs）. 5）According to surveillance in 2011 and 2012, prevalence of drug resistance was 2.6%. Conclusion Positive response in immune reconstitution and viral control had achieved in HAART in Hunan. More attentions on side effects, immunological non responding and drug resistance should be paid in the future.