云南省德宏州3014例艾滋病患者接受抗病毒治疗后药物不良反应分析

目的了解云南省德宏州艾滋病患者接受国家免费抗病毒治疗后90 d内的药物不良反应率及其影响因素。方法采用回顾性队列研究方法,将德宏州2004年7月1日至2009年12月31日开始接受抗病毒治疗、年满16周岁且在治疗后90 d内至少有一次随访记录的全部艾滋病患者纳入研究进行分析。结果共有3 014例患者纳入本研究,平均年龄（35.8±9.9）岁,61.2%是男性,55.4%为少数民族,已婚或同居者占71.4%,55.0%文化程度在小学以下,75.1%职业为农民;感染途径以经异性性传播为主,占67.0%;主要治疗方案为司他夫定（d4T）＋拉米夫定（3TC）＋奈韦拉平（NVP）（53.9%）和齐多夫定（AZT）＋3TC＋NVP（33.4%）。基线评估时相关实验室指标无异常的患者在治疗开始后90 d内,药物不良反应以转氨酶升高（49.0%）、白细胞减少（32.0%）、贫血（23.6%）、消化系统症状（25.8%）和皮疹（10.6%）为主。logistic多因素回归分析显示：女性、年龄较长者、少数民族患者、使用含AZT或依非韦伦（EFV）的治疗方案以及基线CD4＋T淋巴细胞计数水平较低的患者贫血发生率较高;而女性、年龄较长者、汉族、使用含AZT或NVP的治疗方案以及基线CD4＋T淋巴细胞计数水平较低的患者较易发生白细胞减少;男性、年龄长者、文化程度较低者、使用含d4T的治疗方案以及基线CD4＋T淋巴细胞计数较高的患者转氨酶升高发生率较高。结论云南省德宏州艾滋病患者抗病毒治疗后90 d内不良反应发生率高,不良反应发生率与患者人口学特征、基线免疫状态和用药方案有关。临床医生应针对患者特征选择适当的治疗方案以减少药物不良反应的发生,并应熟悉药物不良反应的相关处理。

Adverse effects of antiretroviral treatment among 3014 HIV/AIDS patients in Dehong prefecture,Yunnan

Objective To evaluate the adverse effects of antiretroviral treatment（ART） among HIV/AIDS patients.Methods A retrospective cohort study was performed to evaluate the adverse effects within the first 90 days of ART treatment.We analyzed adverse events for all HIV/AIDS patients aged over 16 years,who started ART from July,2004 to December,2009 and were followed-up for at least 90 days.Results This study included 3 014 HIV infected patients with an average age of 35.8±9.9 years.Among the patients,61.2% were male,55.4% were of ethnic minorities,71.4% were married or living together with their spouses/sex partners,55.0% were illiterate or had only primary school education,75.1% were farmers and 67.0% infected HIV heterosexually.The two main treatment regimens were d4T＋3TC＋NVP（53.9%） or AZT＋3TC＋NVP（33.4%）.Within the first 90 days of ART,49.0% of patients had the elevated levels of serum aminotransferase,32.0% had the reduced numbers of white blood cells,23.6% had anemia,25.8% had the symptoms of digestion system and 10.6% had rash among the patients who had normal laboratory testing results before treatment.A multiple logistic regression analysis indicated that anemia was associated with female,senior,ethnic minority,AZT or EFV treatment and a low baseline CD4＋T cell count;reduced white blood cells was associated with female,senior,ethnic Han,AZT or NVP treatment and a low baseline CD4＋T cell count;and elevated serum aminotransferase level was associated with male,senior,low education level,d4T treatment and normal baseline CD4＋T cell count.Conclusions The incidences of adverse events were high within the first 90 days of ART treatment among HIV/AIDS patients.The treatment adverse effects were associated with the demographic characteristics and CD4＋T cell counts as well as antiretroviral drug regimens.