艾滋病高发地区初治患者一线抗病毒治疗方案的分析  

First-Line Antiviral Therapy for Newly Treated Patients in Areas with High Prevalence of AIDS

作　　者：韦玉素 欧汝志[1] 董文逸[1] 黄欣欣[1] 李雪琴[1] 刘燕芬[1] WEI Yu-su;OU Ru-zhi;DONG Wen-yi;HUANG Xin-xin;LI Xue-qin;LIU Yan-fen(Department of Pharmaceutical Preparation of Nanning Municipal Fourth People’s Hospital,Guangxi AIDS Clinical Treatment Center,Nanning 530023,China)

机构地区：[1]南宁市第四人民医院药剂科广西艾滋病临床治疗中心(南宁)

出　　处：《实用临床医学（江西）》2019年第8期5-7,25,共4页Practical Clinical Medicine

基　　金：广西壮族自治区卫生和计划委员会自筹经费科研课题(Z20170149);南宁市人才小高地专项资金资助项目(2017033)

摘　　要：目的探讨艾滋病(AIDS)一线抗病毒治疗方案的换药原因,为安全合理地用药提供依据。方法回顾性研究2017年2—8月入组初治抗病毒治疗的HIV/AIDS患者476例,随访1年,其中依非韦伦+拉米夫定+替诺福韦(EFV+3TC+TDF)组268例,依非韦伦+拉米夫定+齐多夫定(EFV+3TC+AZT)组89例,奈韦拉平+拉米夫定+齐多夫定(NVP+3TC+AZT)组70例,奈韦拉平+拉米夫定+替诺福韦(NVP+3TC+TDF)组49例,观察4种不同治疗方案第一次换药情况。结果4组总换药率及治疗失败率分别为23.53%和4.83%。其中换药率及治疗失败率EFV+3TC+TDF组分别为11.19%及2.61%;EFV+3TC+AZT组分别为29.21%及0.00%;NVP+3TC+AZT组分别为47.14%及2.86%;NVP+3TC+TDF组分别为46.94%及28.57%。EFV+3TC+TDF组方案换药率低于其他方案,NVP+3TC+TDF组发生治疗失败率最高,且多发生于CD4^+T淋巴细胞计数≤100个 μL^-1的HIV/AIDS患者(均P<0.01)。结论初治HIV/AIDS患者一线方案EFV+3TC+TDF一年内换药率最低,治疗失败率低,可作为首选推荐方案。基线CD4^+T淋巴细胞计数小于100个 μL^-1的初治患者使用NVP+3TC+TDF面临治疗失败的风险比其他治疗方案高,应避免使用。Objective To explore the causes for switching drugs in first-line antiviral therapy for acquired immune deficiency syndrome(AIDS),and to provide evidence for safe and rational drug use.Methods A retrospective study was conducted on 476 patients with newly diagnosed HIV/AIDS in our hospital from February to August,2017.These patients were followed up for one year.Among them,268 were treated with efavirene+lamivudine+tenofovir(EFV+3TC+TDF),89 with efavirenz+lamivudine+zidovudine(EFV+3TC+AZT),70 with nevirapine+lamivudine+zidovudine(NVP+3TC+AZT),and 49 with nevirapine+lamivudine+tenofovir(NVP+3TC+TDF).The first drug change was observed in the four treatment schemes.Results The total drug change rate and treatment failure rate were 23.53% and 4.83% among the 476 patients,respectively.The drug change rate in EFV+3TC+TDF group(11.19%) was lower than that in EFV+3TC+AZT group(29.21%),NVP+3TC+AZT group(47.14%)or NVP+3TC+TDF group(46.94%).The treatment failure rate in NVP+3TC+TDF group(28.57%)was higher than that in EFV+3TC+TDF group(2.61%),EFV+3TC+AZT group(0.00%) or NVP+3TC+AZT group(2.86%).Furthermore,treatment failure mostly occurred in HIV/AIDS patients with CD4 T lymphocyte count≤100·μL^-1(P<0.01).Conclusion EFV+3TC+TDF leads to the lowest rates of drug change and treatment failure in newly treated HIV/AIDS patients within one year.Therefore,the first-line regimen can be recommended as the first choice.NVP+3TC+TDF regimen has a higher risk than other protocols for treatment failure,and its use should be avoided in patients with CD4 T lymphocyte count≤100·μL^-1.

关 键 词：HIV/AIDS 治疗方案 药物更换 

分 类 号：R512.91[医药卫生—内科学]