艾滋病患者更换二线抗病毒药物的治疗效果

Treatment outcomes of HIV-infected patients switched to second-line therapy

ObjectiveTo analyze the virological, immunological responses and drug resistance (DR) and influencing factors of virological failure among patients switched to second-line therapy. MethodsA total of 175 patients who were switched to second-line ART after first-line failure were enrolled in the study. The rates of viral suppression, CD4 cell count and drug resistance before and after the regimen switching were analyzed. ResultsThe rates of viral suppression (VL<1 000 copies/mL) in 12 months, 24 months and 36 months after switching were 73.4%, 79.3% and 92.8%, respectively (trend test, P=0.04). The median count of CD4 cells was increased from 193 cells/μL at baseline to 318, 371 and 378 cells/μL (P<0.01) respectively. The rates of drug resistance at these four time points were 81.1%, 17.3%, 14.0% and 9.6%, respectively (trend test, P<0.01). The rates of NRTI-related and NNRTI-related resistance were 70.9% and 81.1% before switching, and the most frequent NRTI-related resistance mutations were T215CFYI (45.7%), M184V(42.3%) and M41L(40.0%), and the most common NNRTI-related resistance mutations were K103NST (47.4%), Y181C(40.0%) and G190AS (28.0%). No PI-related resistance was found. Having self-reported missing doses after switching was independently associated with the virological failure in 36 months of switching. Conclusions HIV-infected patients experiencing the first-line failure and then switched to second-line regimens have good virological and immunological responses. However, it is necessary to further study the drug resistance and adherence among the patients.