Sungkanuparph Somnuek, Kiertiburanakul Sasisopin, Manosuthi Weerawat, Kiatatchasai Wiphawee, Vibhagool Asda
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
Int J STD AIDS. 2005 Mar;16(3):243-6. doi: 10.1258/0956462053420121.
In developing countries, patients often present late with advanced AIDS and a very low CD4 cell count. A retrospective cohort study was conducted in HIV-infected patients who had been initiated into highly active antiretroviral therapy (HAART) with CD4 cell count < 50 cells/mm3. There were 159 patients of mean age 36.6 years and 60.4% had previous major opportunistic infections. Mean CD4 was 22 cells/mm3 and 80% had HIV RNA > 100,000 copies/mL. The majority of HAART regimens is non-nucleoside reverse transcriptase inhibitor-based (81.8%). In as-treated analysis, 50, 71.2, 79.7, 79.4, and 80.1% of patients achieved undetectable HIV RNA (< 50 copies/mL) at 12, 24, 36, 48, and 60 weeks, respectively. The corresponding mean CD4 counts were 95, 125, 166, 201, and 225 cells/mm3. Twenty two patients (13.8%) had adverse drug events and half of these had to discontinue HAART. Initiation of HAART in advanced AIDS with CD4 cell count < 50 cells/mm3 is effective, safe, and well tolerated and should not be delayed.
在发展中国家，患者常常在艾滋病晚期才前来就诊，且CD4细胞计数极低。对CD4细胞计数<50个细胞/mm³且已开始接受高效抗逆转录病毒疗法（HAART）的HIV感染患者进行了一项回顾性队列研究。共有159例患者，平均年龄36.6岁，60.4%曾发生过严重的机会性感染。平均CD4计数为22个细胞/mm³，80%的患者HIV RNA>100,000拷贝/mL。大多数HAART方案是以非核苷类逆转录酶抑制剂为基础的（81.8%）。在实际治疗分析中，分别有50%、71.2%、79.7%、79.4%和80.1%的患者在12、24、36、48和60周时实现了HIV RNA检测不到（<50拷贝/mL）。相应的平均CD4计数分别为95、125、166、201和225个细胞/mm³。22例患者（13.8%）发生了药物不良事件，其中一半不得不停止HAART治疗。对于CD4细胞计数<50个细胞/mm³的晚期艾滋病患者，启动HAART治疗是有效、安全且耐受性良好的，不应延迟。
