214例HIV/AIDS病人的HAART不良反应及换药原因分析

目的探讨艾滋病病毒（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）的不良反应及换药原因。为保证HAART合理用药及用药安全提供依据。方法全部病人均使用国家免费艾滋病HAART药物,按照国家免费艾滋病抗病毒药物治疗手册要求,全部病例均在HAART后1、2、3、6、9、12个月随访1次,统计病人不良反应及换药原因,数据分析用SPSS 19.0软件处理,以P〈0.05为差异有统计学意义。结果 95例病人中90例出现抗病毒药物不良反应、3例一线治疗失败、2例因药物配伍禁忌更换抗病毒药物。其中90例病人因AZT、NVP、D4T不良反应更换抗病毒药物。另有3例初始HAART方案包含EFV的病人,出现神经系统症状,均自行缓解,未更换药物。将初始HAART方案包含AZT、NVP、D4T的病例分为未换药组和换药组,将两组病人的基线CD＋4T淋巴细胞（简称CD4细胞）计数值进行统计学比较,差异无统计学意义。结论HAART的主要换药原因为抗病毒药物不良反应。在包含AZT、D4T、NVP的HAART方案中,治疗前3个月着重监测AZT、NVP的不良反应,治疗6个月后着重监测D4T的不良反应,且不良反应的出现与基线CD4细胞计数无关。同时须及早发现耐药,并须掌握药物配伍禁忌。

The adverse reactions and causes of drug switch in 214 HIV/AIDS patients with HAART

Objective To investigate the adverse reaction and causes of drug switch in HIV/AIDS patients with highly active antiretroviral therapy （HAART）, in order to provide the basis for the rational use of drugs and drug safety. Methods All the patients took free national antiretroviral drugs. According to the requirements of free na- tional antiretroviral treatment manual, all patients were followed up at 1, 2, 3, 6, 9 and 12 months after HAART, collecting data of adverse reaction and causes of drug switch. The data was analyzed using SPSS 19.0 software. P〈 0.05 was considered statistically significant. Results There were 95 patients switching antiretroviral drugs due to adverse reaction（90 cases, for drug adverse reaction of AZT, NVP or D4T）, first-line treatment failure（3 cases） and drug incompatibility（2 cases）. There were 3 patients initially treated with regimens containing EFV suffered from nervous system symptoms, but they alleviated by themselves within one month after HAART and did not switch the drug. If the patients with initial regimens containing AZT, NVP, D4T were divided into drug switch and no switch groups, there were no differences in baseline CD4^＋ T lymphocyte counts between the two groups. Conelusion The main reason for drug switch in HAART is drug adverse reaction. In regimens containing AZT, D4T and/or NVP, adverse reactions of AZT and NVP should be closely monitored in early three months of treatment, and adverse reactions of D4T should be monitored after 6 months of treatment. Adverse reactions have no relationship with baseline CD）T lymphocyte counts. At the same time signs of antiretroviral drugs resistance should be timely found, and drug incompatibility should be mastered.