确山县抗HIV治疗效果的实验室评价及分析  

The laboratory evaluation and analysis of curative effect of anti-HIV treatment in Queshan county of Henan province.

作　　者：姜树林 [1] 王哲 [2] 邢辉 [1] 崔为国 [2] 司雪峰 [1] 朱新朋 [2] 王玉 [1] 李福安  彭虹 [1] 王连恩  全宇 [1] 马鹏飞 [1] 阮玉华 [1] 邵一鸣  

机构地区：[1]中国疾病预防控制中心性病艾滋病预防控制中心,北京,100050 [2]河南省疾病预防控制中心,郑州,450003 [3]确山县疾病预防控制中心,河南,确山,463200

出　　处：《中国艾滋病性病》2005年第2期81-83,共3页Chinese Journal of Aids & STD

基　　金：卫生部艾滋病防治应用性研究项目资助 (WA2 0 0 3 - 0 1 )

摘　　要：目的　了解确山县抗艾滋病病毒(HIV)治疗过程中,接受治疗(治疗方案为齐多夫定胶囊、去羟基甘散和奈韦拉平片)的患者的免疫学和病毒学指标的变化和耐药毒株的出现情况。方法　对已开展抗HIV治疗的确山县部分接受治疗的HIV感染者进行了横断面调查(平均治疗时间为5 2个月) ,并在8个月后对该人群进行了随访,观察血浆病毒载量(VL)、CD+ 4 T淋巴细胞计数的变化以及耐药突变出现的情况。结果　①8个月后VL低于检测限的病人的比例显著降低(横断面调查时为5 1 .1 %,随访时降为31 9%,P <0 . 0 5 ) ;②服药依从性<95 %的患者血浆VL显著升高(平均升高0 5 2log ,P <0 . 0 5 ) ,而CD+ 4 T淋巴细胞计数显著降低(平均降低96个/ μl,P <0 . 0 5 ) ;③随着治疗时间的延长耐药突变率由5 3 .7%上升到6 9. 8%。结论　应加强对病人的管理,提高服药依从性,降低耐药性的产生速度,保证治疗效果;及时对治疗病人进行耐药性监测,防止耐药毒株的传播。Objective To find out the alterations of the immunological and virological indexes and the emergence of resistant strains in the patients undergoing anti-HIV therapy(receiving Zidovudine,Didanosine and Nevirapine).Methods The cross sectional survey was performed in the HIV infected patients receiving antiretroviral treatment(the average treated time was 5.2 months) in Queshan county of Henan province and the patients were followed up after 8 months.The plasma viral load,CD_4 cell counts and the emergence of resistant strains of HIV-1 were studied.Results 1) The proportion of patients whose plasma viral load below the detection limit significantly decreased after 8 months(from 51.1% at the cross sectional survey to 31.9% at the follow-up study,P<0.05). 2) The plasma viral load significantly increased(averagely increased 0.52log,P<0.05) and the CD_4 cell counts significantly decreased(averagely decreased 96cells/mm3,P<0.05) in the patients whose adherence to therapy were less than 95%. 3) The rate of the resistance mutations increased from 53.7% to 69.8% with the elongation of the therapeutic duration.Conclusion Strengthening the supervision on the patients undergoing therapy was necessary to enhance the adherence to therapy and reduce the emergence speed of the resistant strains and thus consolidate the therapeutic effects;and more attention is needed to be paid on monitoring of the drug-resistance status to prevent the spread of resistant strains.

关 键 词：艾滋病 高效抗逆转录病毒疗法 病毒载量 CD4^+淋巴细胞计数 耐药性 

分 类 号：R512.91[医药卫生—内科学]