Liu Jia, Cui Wei-guo, Xue Xiu-juan, Sun Guo-qing, Tian Sui-an, Liu Chun-hua, Cheng Yao-wu, Wang Zhe
Henan Provincial Center of Disease Control and Prevention, Zhengzhou 450016, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2012 Sep;33(9):893-7.
To analyze the situation of AIDS patients who had received replaced therapy program in Henan province.
84 AIDS patients had been enrolled into the national free first-line antiretroviral treatment for more than 5 years and would soon be replaced with another antiretroviral treatment program, were selected to a follow-up program to be carried out six months later. Data on CD4(+) t-lymphocyte count, viral load and genotypic resistance were included in the study.
The DDI+AZT+NVP treatment program was used by all the 84 patients at baseline. A replacement by 3TC + AZT + NVP (post first-line) in 31 patients and 3TC + TDF + LPV/r (second-line) in another 53 patients were taken place within a week. All the patients were followed for six months.
showed that: all of the 84 patients appeared an amelioration of CD4(+) t-lymphocyte count median from the baseline of 374.00 cell/µl to 406.50 cell/µl (P = 0.005). Those patients who had changed to second-line treatment program also showed an improvement of CD4(+) t-lymphocyte count median from the baseline of 267.00 cell/µl to 365.00 cell/µl (P = 0.015), while patients who were on the post first-line program with their CD4(+) t-lymphocyte count mean did not show significant change as compared to the baseline (P = 0.158) data. All the 84 patients showed a decrease of virus load median from the baseline of 3.61 log(10)copies/ml to 0.00 log(10) copies/ml (P = 0.000). Both of the two types of patients who had been changed to different programs, had a lower virus load median in the end of the follow-up period (for post first-line: P = 0.007; for second-line: P = 0.000). 13 patients kept their viral load more than 1000 copies/ml, including 5 cases bore more than three thymidine analogue mutations (TAMs) a the end of the follow-up program. Another 4 patients had no resistance mutations detected and no significant variation of viral load (less than 3 times) in the pre- or post-surveys.
AIDS patients who had received long-term first-line antiretroviral treatment program, showed an amelioration six months after changing of the treatment program. Timely and effective testing on drug resistance as well as the strengthening of the follow-up program still seemed to be the link to those patients who were receiving first-line treatment that should not be ignored.
分析河南省接受更换治疗方案的艾滋病患者情况。
选取84例接受国家免费一线抗逆转录病毒治疗超过5年且即将更换为另一抗逆转录病毒治疗方案的艾滋病患者，进行6个月后的随访。研究纳入CD4(+) T淋巴细胞计数、病毒载量和基因型耐药性数据。
84例患者基线时均采用司他夫定（DDI）+齐多夫定（AZT）+奈韦拉平（NVP）治疗方案。1周内，31例患者更换为拉米夫定（3TC）+AZT+NVP（一线治疗后），另外53例患者更换为3TC+替诺福韦酯（TDF）+洛匹那韦/利托那韦（LPV/r）（二线治疗）。所有患者均随访6个月。
84例患者CD4(+) T淋巴细胞计数中位数均有改善，从基线的374.00个细胞/μl升至406.50个细胞/μl（P = 0.005）。更换为二线治疗方案的患者CD4(+) T淋巴细胞计数中位数也有改善，从基线的267.00个细胞/μl升至365.00个细胞/μl（P = 0.015），而接受一线治疗后方案的患者CD4(+) T淋巴细胞计数平均值与基线相比无显著变化（P = 0.158）。84例患者病毒载量中位数均从基线的3.61 log(10)拷贝/ml降至0.00 log(10)拷贝/ml（P = 0.000）。更换为不同方案的两类患者在随访期末病毒载量中位数均较低（一线治疗后：P = 0.007；二线治疗：P = 0.000）。13例患者病毒载量持续高于1000拷贝/ml，其中5例在随访期末出现3个以上胸苷类似物突变（TAM）。另外4例患者未检测到耐药突变，且前后调查病毒载量无显著变化（小于3倍）。
接受长期一线抗逆转录病毒治疗方案的艾滋病患者，更换治疗方案6个月后情况有所改善。对耐药性进行及时有效的检测以及加强随访方案，仍是接受一线治疗患者不容忽视的环节。
