人类免疫缺陷病毒／丙型肝炎病毒合并感染抗反转录病毒治疗时机选择  

The selection of antiretroviral therapy timing for patients with human immunodeficiency virus/hepatitis C virus co-infection

作　　者：卢瑞朝 张勇 李虹如 徐彩玲 梁月新 窦艳云 蔡卫平[2] 

机构地区：[1]广西壮族自治区龙潭医院感染科,柳州545005 [2]广州市第八人民医院感染科

出　　处：《中华传染病杂志》2013年第6期342-346,共5页Chinese Journal of Infectious Diseases

基　　金：十二五国家科技重大专项（2012ZX10001-003-003）;成人艾滋病适宜治疗策略研究与应用;广西壮族自治区卫生厅重点科研课题（200989重）;HIV合并HCV感染抗反转录病毒治疗时机选择研究

摘　　要：目的探讨HIV／HCV合并感染抗反转录病毒治疗时机及方案的选择。方法人组病例分为HIV／HCV合并感染组和HIV单纯感染组，再将HIV／HCV合并感染组分为HIV／HCV＋高CD4组（CD4^＋T淋巴细胞计数为200～350μL）和HIV／HCV＋低CD4组（CD4^＋T淋巴细胞计数〈200／μL）。采用随机双盲法，Spw-Pb网络数据平台按l：1：1将各组随机分为3个亚组，分别采用齐多夫定（AZT）或司他夫定（D4T）＋拉米夫定（3TC）＋奈韦拉平（NVP）方案、AZT（D4T）＋3TC＋依非韦伦（EFV）方案和AZT（D4T）＋3TC＋克力芝（LPV/R）方案。HIV/HCV＋高CD4组同时用聚乙二醇干扰素-α-2a 180μg/次每周1次皮下注射、利巴韦林900～1200mg／d，疗程1年。检测患者基线CD4^＋T淋巴细胞、ALT，并于治疗后24、48、72周复查；治疗后24、48、72周检测HIV载量；随访记录患者不良反应。计量资料多组间比较采用单因素方差分析，组间两两比较采用LSD-t检验，治疗组与对照组比较采用独立样本t检验；计数资料比较采用卡方检验。结果2008年10月至2010年6月符合HIV/HCV合并感染入组病例120例，其中HIV／HCV＋高CD4组63例，HIV/HCV＋低CI）4组57例，HIV单纯感染组60例。共58例患者采用NVP为基础方案，61例采用EFV为基础方案，61例采用LPV／R为基础方案。与基线值比较，治疗48周后HIV／HCV＋高CD4组（204/μL，比335／μL，t=-9．876，P=0．000）、HIV／HCV＋低CD4组（154／μL比185／μL，t=3．272，P=0．001）、HIV单纯感染组（184／μL比272／μL，t=-5．632，P=0．000）CD4^＋T淋巴细胞计数均明显升高；治疗48、72周后，3组患者HIV载量均低于检测下限。治疗48周后，3种治疗方案组患者CD4^＋T淋巴细胞计数均较基线值有不同程度地增加，其中以AZT（D4T）＋3TC＋LPV／R方案增幅最大。治疗24周后，3种治疗方案组患者ALT升高患者比例明显增加，其中AZT（D4T）＋3TC＋NVP方Objective To investigate the best timing and regimen of antiretroviral therapy for patients with human immunodefieiency virus （HIV）/hepatitis C virus （HCV） co infection. Methods Patients with HIV/HCV co infection were enrolled, and divided into group A （CD4＋ T cell count 200-350/μL） and group B （CD4＋ T cell count 〈200/μL）. Patients in group A and group B were randomly assigned to subgroup A1, A2, A3 and B1, B2, B3 through the Spw-Pb Network Data Platform, respectively, with the ratio of 1：1：1. Nevirapine （NVP） was adopted as the basic regimen in subgroups A1 and B1; efavirenz （EFV） was adopted as the basic regimen in subgroups A2 and B2; lopinavir/ritonavir （LPV/R） was adopted as the basic regimen in subgroups A3 and B3. Patients in group A were also administered with Peginterferon-α-2a （Pegasys） 180 μg once every week subcutaneously and ribavirin 900 1200 mg/d as anti-HCV therapy, with the course of 1 year. Group C （HIV monoinfection group） had 60 cases, including 30 cases of CD4＋ T cell count 200-350μL, and 30 cases of CD4＋ T cell count 〈200/μL. All the 60 cases were randomized into subgroups C1, C2 and C3, and received antiretroviral therapy based on the above three regimens, respectively. CD4＋T cell count and alanine aminotransferase （ALT） were measured at baseline, and reassessed at week 24, 48 and 72. HIV viral load were detected at week 24, 48 and 72 of treatment. The adverse events of patients were documented. Measurement data were analyzed by one-way analysis of variance, LSD-t test and independent-sample t test, while categorical data were compared by chi square test. Results Patients were enrolled from October 2008 to June 2010. At week 48, CD4＋ T lymphocyte count of groupA（335/μL vs 204/μL; t=-9.876, P= 0.000）, groupB （185/μL vs 154/μL; t= 3.272, P=0.001）, and group C （272/μL vs 184/μL; t= -5. 632, P= 0. 000） were all significantly increased compared with baseline. At week 48 and 72, HIV load of the three groups were a

关 键 词：HIV 肝炎病毒属 重叠感染 抗逆转录病毒治疗 高效 CD4阳性T淋巴细胞 

分 类 号：R51[医药卫生—内科学]