基于PI的二线抗逆转录病毒治疗对HIV/AIDS患者异常免疫活化的影响  

Effects of PI-based second-line antiretroviral therapy on abnormal immune activation in patients with HIV/AIDS

作　　者：李彦媚[1] 张雯[2] 黄英秀[1] 田云飞[2] 苏文晶[1] 郝禹[2] 韩宁[2] 杨涤[2] 宋川[2] 肖江[2] 赵红心[1] 

机构地区：[1]北京大学北京地坛医院教学医院,北京100015 [2]首都医科大学附属北京地坛医院

出　　处：《中华实验和临床感染病杂志（电子版）》2013年第2期101-104,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：北京市朝阳区艾滋病和病毒性肝炎等重大传染病综合防治示范区建设研究(No.2012ZX10004-904);二线抗病毒药物对艾滋病治疗失败患者单核细胞的影响(No.2009-3153);北京市卫生系统高层次卫生技术人才培养

摘　　要：目的观察以非核苷类逆转录酶抑制剂(NNRTI)为基础的一线高效抗逆转录病毒治疗(HAART)失败的HIV/AIDS患者更换为以蛋白酶抑制剂(PI)为基础的二线HAART后对体内免疫活化的影响。方法收集以NNRTI为基础的一线HAART失败后的患者共30例,更换为以PI为基础的二线HAART方案,对患者进行0、12、24、36和48周的队列随访研究。检测患者血浆病毒载量和外周血CD4+T细胞计数,评价抗病毒治疗效果;进一步检测外周血CD8+T淋巴细胞免疫活化指标CD38、人类白细胞抗原DR(HLA-DR)的动态变化,评价以PI为基础的二线HAART方案对异常免疫活化的影响。结果患者接受以PI为基础的二线HAART后,血浆病毒复制得到有效抑制,CD4+T细胞计数增加;入组HIV/AIDS患者基线CD38+CD8+T细胞百分比高于正常,经过二线HAART后恢复正常;HLA-DR+CD8+T细胞百分比基线水平高于正常对照,治疗48周后无显著下降。结论以PI为基础的二线HAART方案具有强大的免疫重建功能,能够有效地抑制病毒复制,恢复CD4+T细胞计数水平,并可在一定程度上降低体内免疫活化水平,延缓疾病进展。Objective To investigate the effect of PI-based second-line highly active anti-retroviral therapy （HAART） on immune activation in HIV/AIDS patients with non-nucleoside reverse transcriptase inhibitors （NNRTI）-based first-line HAART failure. Methods Total of 30 individuals with NNRTI-based first- line HAART treatment failure were enrolled in the study, the regimen was replaced by protease inhibitor （PI）- based second-line HAART. Patients were followed up at 0, 12, 24, 36 and 48 weeks for a longitudinal study. The plasma HIV viral load and CD4＋ T-cell counts in peripheral blood were analyzed, respectively, and the effect of anti-retroviral therapy was determined. The immune activation markers CD38, human leukocyte antigen DR （HLA-DR） on CD8＋ T lymphocyte of peripheral blood were furtherly tested dynamically, to evaluate the effect of PI-based second line HAART regimen on abnormal immune activation. Results The PI-based second- line HAART reduced the HIV replication and increased CD4＋ T-cell counts effectively. Patients with HIV/ AIDS had a higher percentage of CD38＋CD8＋ T-cell than normal control at baseline and recovered after the second-line HAART of 48 weeks. The percentage of HLA-DR＋CD8＋ T-cell in HIV/AIDS patients was higher than that in healthy controls at baseline, however, there was no significant reduction after the therapy of 48 weeks. Conclusions PI-based second-line HAART regimen had powerful immune reconstitution function on suppression of virus replication, recover of CD4＋ T-cell counts and reduction of the immune activation level at a certain extent. Furthermore, the therapy attenuated the progression of disease.

关 键 词：蛋白酶抑制剂 获得性免疫缺陷综合征 免疫活化 

分 类 号：R512.91[医药卫生—内科学]