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含马拉韦罗方案在常规临床实践中的长期免疫病毒学效应及耐受性

Long-term immunovirogical effect and tolerability of a maraviroc-containing regimen in routine clinical practice.

作者信息

Genebat Miguel, Ruiz-Mateos Ezequiel, Pulido Ildefonso, González-Serna Alejandro, García-Pergañeda Antonio, Méndez Gema, Romero-Sánchez María Concepción, Ferrando-Martínez Sara, Leal Manuel

机构信息

Biochemistry Department, Virgen del Rocío University Hospital, Biomedicine Institute of Seville, Spain.

出版信息

Curr HIV Res. 2010 Sep;8(6):482-6. doi: 10.2174/157016210793499295.

Abstract

OBJECTIVES

to analyze the long-term immunovirological effect and tolerability of a maraviroc-containing antiretroviral therapy in viraemic and pretreated HIV-infected patients with a high prevalence of hepatitis C virus (HCV) coinfection.

METHODS

forty-six R5 HIV-infected patients (48% HCV-coinfected) started a maraviroc-containing antiretroviral regimen, including patients with multidrug resistant virus and patients after first virologic failure. A retrospective study was performed, analysing percentage of patients with undetectable viral load, mean CD4+ gain, liver enzymes, clinical events and treatment modification up to week 48.

RESULTS

Raltegravir plus a boosted protease inhibitor was combined with maraviroc in 65.2% of the patients (mainly patients with multidrug resistant virus), while the coformulation lamivudine/abacavir was combined with maraviroc in 26.1% (all of them patients after first virologic failure). After 48 weeks on maraviroc-containing regimen, 96.3% of the patients had achieved undetectability and a mean CD4+ count increase of 151 cells/mm3 was observed. Liver enzymes did not increase along the follow up. One patient died after 24 weeks follow up due to heroin overdose. One patient developed a non-Hodgkin lymphoma after 36 weeks follow up, despite undetectable viral load and significant CD4+ increase was achieved (the only AIDS-defining event observed). Treatment modification was performed in 19.6% of the patients: 77.7% of them experienced a treatment simplification and only 1/46 suspended maraviroc.

CONCLUSIONS

maraviroc-containing regimen is long-term effective and well tolerated in HIV-infected patients in routine clinical practice and in different clinical scenarios.

摘要

目的

分析含马拉维若的抗逆转录病毒疗法对病毒血症且曾接受治疗的丙型肝炎病毒(HCV)合并感染率高的HIV感染患者的长期免疫病毒学效应及耐受性。

方法

46例R5型HIV感染患者(48%合并HCV感染)开始接受含马拉维若的抗逆转录病毒治疗方案,包括多药耐药病毒患者及首次病毒学失败后的患者。进行一项回顾性研究,分析至第48周时病毒载量不可测的患者百分比、CD4+平均增加量、肝酶、临床事件及治疗调整情况。

结果

65.2%的患者将拉替拉韦加增强型蛋白酶抑制剂与马拉维若联合使用(主要是多药耐药病毒患者),而26.1%的患者将拉米夫定/阿巴卡韦复方制剂与马拉维若联合使用(均为首次病毒学失败后的患者)。接受含马拉维若方案治疗48周后,96.3%的患者实现了病毒载量不可测,且观察到CD4+计数平均增加151个细胞/mm³。随访期间肝酶未升高。1例患者在随访24周后因海洛因过量死亡。1例患者在随访36周后发生非霍奇金淋巴瘤,尽管病毒载量不可测且CD4+显著增加(观察到的唯一艾滋病定义事件)。19.6%的患者进行了治疗调整:其中77.7%的患者接受了治疗简化,仅1/46的患者停用了马拉维若。

结论

在常规临床实践及不同临床情况下,含马拉维若的方案对HIV感染患者具有长期有效性且耐受性良好。

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