含洛匹那韦/利托那韦的初治抗病毒方案治疗HIV/HCV合并感染者的疗效观察

目的研究含洛匹那韦/利托那韦（LPV/r）的抗病毒治疗方案,治疗合并感染丙型肝炎病毒（HCV）的艾滋病病人（HIV/HCV合并感染）的疗效与安全性。方法 52例未接受过抗病毒治疗的HIV/HCV合并感染者,随机分为研究组（26人）和对照组（26人）,研究组给予替诺福韦（TDF）＋拉米夫定（3TC）＋LPV/r方案治疗,对照组给予TDF＋3TC＋依非韦伦（EFV）方案治疗,随访48周。观察指标包括两组病毒载量、CD＋4T淋巴细胞（简称CD4细胞）计数、丙氨酸转氨酶（ALT）、总胆固醇（TC）和甘油三酯（TG）水平,此外观察两组不良反应发生情况。结果48周后,研究组和对照组患者病毒载量均降至50拷贝/mL以下;两组ALT水平接近,差异无统计学意义（72.8±16.4）U/L vs.（81.2±20.5）U/L,P=0.109];与对照组相比,研究组CD4细胞计数更高（282.4±105.8）/μL vs.（187.6±110.2）/μL,P=0.003];同时TC和TG水平也明显增高,差异有统计学意义TC：（6.24±1.83）mmol/L vs.（4.28±0.84）mmol/L,P=0.038;TG：（3.32±1.25）mmol/L vs.（1.55±0.78）mmol/L,P=0.011]。研究组共3例（11.54%）报告有不良反应,其中1例恶心、呕吐,2例腹泻;对照组共出现5例不良反应（19.23%）,均为头晕。两组不良反应发生率差异无统计学意义（P〉0.05）。结论含LPV/r方案与含EFV抗病毒方案对HIV/HCV合并感染者抗病毒效果接近;含LPV/r方案更有利于CD4细胞计数的提升,但可能引起血脂升高。

The efficacy and safety of Iopinavir/ritonavir-containing antiretroviral regimen in HIV/AIDS patients coinfected with hepatitis C

Objective To investigate the efficacy and safety of LPV/r（Kaletra） containing regimens on HIV/ HCV co-infection. Methods Fifty-two antiretroviral-naive HIV/HCV coinfected patientswere enrolled and randomized into investigational group （n = 26） and control group（n = 26）. The former were given tenofovir （TDF）, lamivudine （3TC） plus LPV/r, while the latter were administered with TDF, 3TC plus Efavirdine （EFV）. All the patients were followed up for 48 weeks. Observational parameters included HIV loads, CD4 lymphocyte counts, Alanine aminotransferase （ALT）, total cholesterol （TC） and triglycerides （TG）. Meanwhile, adverse reactions were also observed during the 48 weeks of therapy. Results After 48 weeks, viral loads were reduced to less than 50 copies/ml in both the investigational group and the control group. The levels of ALT were similar in the two groups without significance difference -（72.8±16.4） U/L vs （81.2±20.5） U/L, P=0. 109]. Compared with the control group, the investigational group had significantly higher level of CD4 lymphocytes （282.4±105.8） a/μL vs （187.6 ±110.2） a/gL, P=0. 003], TC and TGTC.. （6. 244±1.83） mmol/L vs （4. 28±0.84） mmol/L, P=0. 038; TG ： （3. 32±1.25） mmol/L vs （1.55 ± 0.78） mmol/L, P=0. 011]. Conclusion The efficacy of LPV/r-based regimen and EFV-based regimen are similar in HIV/HCV coinfection. The former regimen may increase CD4^＋ T lymphocyte count significantly, but may also cause hyperlipidemia.