HIV/AIDS患者不同HAART方案疗效及对CD4+T和病毒载量的影响

目的 探讨人类免疫缺陷病毒（HIV）/获得性免疫缺陷综合征（AIDS）患者以不同高效联合抗反转录病毒治疗（HAART）方案疗效及对CD4⁺T细胞和病毒载量的影响。方法 将2015年6月—2020年6月广安市人民医院收治150例HIV/AIDS为研究对象,依据HAART方案分为替诺福韦（TDF）组和齐多夫定（AZT）组各75例。比较两组患者疗效、治疗后不同时间血浆病毒载量和CD4⁺T细胞变化,采用WHO生存质量艾滋病专用量表简表（WHOQOL-HIV BREF）测试治疗前及治疗12个月的生存质量,比较两组不良反应发生情况。结果 TDF组总有效率为93.33%（70/75）,AZT组总有效率为89.33%（67/75）,两组总有效率比较差异无统计学意义（P>0.05）。TDF和AZT组治疗前HIV病毒载量<40 copies/mL分别为4例（占5.33%）和5例（占6.67%）,经治疗12个月 HAART,患者 HIV病毒载量明显下降,<40 copies/mL分别为65例（占86.67%）和60例（占80.00%）,两组治疗前后差异有统计学意义（χ²=41.681,99.866,P<0.05）。两组患者治疗前和治疗3、12个月HIV病毒载量在<40、40~<200和≥200 copies/mL的比例比较差异无统计学意义（P>0.05）。TDF和AZT组治疗前、治疗12个月CD4⁺T细胞分别为（250.22±88.12）个/μL和（244.89±83.97）个/μL、（394.44±155.28）个/μL和（373.17±146.61）个/μL,TDF和AZT组治疗12个月CD4⁺T细胞明显升高,差异有统计学意义（χ²=10.263,9.636, P<0.05）,两组治疗前、治疗3、6和12个月CD4⁺T细胞数差异无统计学意义（P>0.05）。TDF和AZT组分别治疗12个月,WHOQOL-HIV BREF 8个维度评分均明显高于治疗前（P<0.05）。两组白细胞下降、肝功能异常、疲倦乏力、恶心呕吐、头晕头痛、腹泻发生率比较无统计学意义（P>0.05）。结论 替诺福韦（TDF）+拉米夫定（3TC）+依非韦伦（EFV）、齐多夫定（AZT）+拉米夫定（3TC）+依非韦伦（EFV）两种不同HAART方案治疗HIV/AIDS均具有良好疗效,能够降低血浆HIV病毒载量,提升CD4⁺T淋巴细胞计数水平,改善患者生存质量。

Efficacy of different HAART regimens on patients with HIV/AIDS and influence on CD4+ T lymphocyte and viral load

Objective To explore the efficacy of different highly active anti-retroviral therapy (HAART) regimens on patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and influence on CD4⁺ T lymphocyte and viral load. Methods Totally 150 patients with HIV/AIDS admitted to Guang'an People' s Hospital between June 2015 and June 2020 were taken as the research subjects. According to the HAART regimens, the patients were divided into tenofovir (TDF) group and zidovudine (AZT) group, with 75 cases in each group. The efficacy and changes of viral load and CD4⁺ T lymphocyte at different time points after treatment were compared between the two groups. World Health Organization Quality of Life Human Immunodeficiency Virus Scale (WHOQOL-HIV BREF) was used to measure the quality of life before treatment and after 12 months of treatment, and the occurrence of adverse reactions of the two groups were compared. Results The total effective rate was 93.33% (70/75) in TDF group and 89.33% (67/75) in AZT group, and there was no statistically significant difference in the total effective rate between the two groups (P>0.05). The number of HIV viral load<40 copies/mL was 4 cases (5.33%) in TDF group and 5 cases in AZT group (6.67%) before treatment, and HIV viral load was decreased significantly after 12 months of treatment and the number of HIV viral load<40 copies/mL was 65 cases (86.67%) and 60 cases (80.00%) respectively, and there were statistically significant differences between the two groups before and after treatment (χ²=41.681, 99.866, P<0.05). There were no significant differences in the proportions of HIV viral load< 40, 40-< 200 and ≥200 copies/mL between the two groups before treatment and after 3 and 12 months of treatment (P>0.05). The levels of CD4⁺ T lymphocyte before treatment and after 12 months of treatment were (250.22±88.12) cells/μL and (394.44±155.28) cells/μL in TDF group and were (244.89±83.97) cells/μL and (373.17±146.61) cells/μL in AZT group, and the levels of CD4⁺ T lymphocyte were significantly increased in TDF group and AZT group after 12 months of treatment (χ²=10.263, 9.636, P<0.05). There was no significant difference in the level of CD4⁺T lymphocyte before treatment and after 3, 6 and 12 months of treatment between the two groups (P>0.05). The differences in the scores of WHOQOL-HIV BREF were not significant between the two groups before treatment (P>0.05). There were no significant differences in the incidence rates of white blood cell decline, abnormal liver function, fatigue, nausea and vomiting, dizziness and headache, and diarrhea between the two groups (P>0.05). Conclusion Two different HAART regimens of TDF+ lamivudine (3TC) + efavirenz (EFV), and AZT + 3TC + EFV both have a good efficacy in the treatment of HIV/AIDS, and can reduce the plasma viral load, increase the CD4⁺ T lymphocyte count and improve the quality of life of patients.