Rasooli-Nejad Mehrnaz, Khazaee-Pool Maryam, Abbasian Ladan, Bayat Jozani Zahra, Ahsani-Nasab Sara, Moradmand Badie Banafsheh, Pargar Afsaneh, Esmaeeli Djavid Gholamreza
Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Infectious Diseases, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Department of Health Education and Promotion, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran.
Acta Med Iran. 2017 Apr;55(4):233-240.
There are limited documents about HIV patients switched to second-line antiretroviral therapy (ART) in resource-limited countries. We aimed to assess the efficacy of second-line ART for HIV patients following first-line ART failure. This was a cohort study of HIV/AIDS patients with first-line ART treatment failure switched to second-line ART between January 2004 and March 2014, who followed for at least 12 months after switching. Fifty of studied patients (85%) were treated with regimens containing lopinavir/ritonavir (Kaletra) and nine of them (15%) treated with other regimes. Seven patients were experienced opportunistic infections in accordance with stage III and IV WHO classification. In this way, 11.8% of patients had aclinicalfailure, and 37 of them (62%) had immunological responses. Weight gain was evident in these patients, and there was a significant correlation between theincrease in CD4 and weight gain (P=0.007). Only 13 patients achieved HIV viral load testing that 6 of them had avirological response after 12 months on second-line ART. No significant associations were found between virological or immunological response and gender, age, and lopinavir/ritonavir regimens (P>0.05).With counselling and supporting in those failing first-line ART, inessential switching to more costly second-line ART can be prevented in the majority of patients. However, patients' need to second-line ART drugs has increased, for which national ART programmes and regular follow-up should be organized. The high cost of these drugs and limited access to viral load testing are main barriers to proper management of patients switched to second-line ART regimens.
在资源有限的国家，关于转换为二线抗逆转录病毒疗法（ART）的HIV患者的文献有限。我们旨在评估一线ART治疗失败后二线ART对HIV患者的疗效。这是一项队列研究，研究对象为2004年1月至2014年3月期间一线ART治疗失败后转换为二线ART的HIV/AIDS患者，转换后至少随访12个月。50名研究患者（85%）接受了含洛匹那韦/利托那韦（克力芝）的治疗方案，其中9名（15%）接受了其他方案治疗。7名患者根据世界卫生组织III期和IV期分类发生了机会性感染。这样，11.8%的患者出现临床失败，其中37名（62%）有免疫反应。这些患者体重明显增加，CD4增加与体重增加之间存在显著相关性（P=0.007）。只有13名患者进行了HIV病毒载量检测，其中6名在二线ART治疗12个月后有病毒学反应。在病毒学或免疫反应与性别、年龄和洛匹那韦/利托那韦治疗方案之间未发现显著关联（P>0.05）。通过对一线ART治疗失败患者的咨询和支持，大多数患者可避免不必要地转换为更昂贵的二线ART。然而，患者对二线ART药物的需求增加，对此应组织国家ART项目和定期随访。这些药物的高成本和病毒载量检测的有限可及性是转换为二线ART治疗方案患者合理管理的主要障碍。
