早期高效抗艾滋病逆转录病毒治疗对HIV育龄妇女抗病毒治疗效果和安全性的影响  

Impact of early HAART on anti-HIV efficacy and safety in fertile women

作　　者：刘帅凤[1] 邓小娥[1] 孟琴[1] 李春英[1] 刘伟[1] 梁富雄[1] 曾雪梅[1] LIU Shuaifeng;DENG Xiaoe;MENG Qin;LI Chunying;LIU Wei;LIANG Fuxiong;ZENG Xuemei(Guangxi Center for Disease Prevention and Control,Guangxi 530028,China)

机构地区：[1]广西壮族自治区疾病预防控制中心,南宁530028

出　　处：《实用医学杂志》2021年第5期616-619,625,共5页The Journal of Practical Medicine

基　　金：国家科技重大专项(编号:2018ZX10715008);广西壮族自治区卫生与计划生育委员会科研课题项目(编号:Z2016443,Z2016723);“八桂学者”艾滋病防控关键技术岗位。

摘　　要：目的探讨早期高效抗艾滋病逆转录病毒治疗(HAART)对无症状HIV阳性育龄妇女的治疗效果和安全性的影响。方法选择广西CD4细胞≥400个/μL的无症状HIV妇女104例,其产前接受过母婴阻断,52例产后继续接受HAART(A组)或52例产后中断HAART(B组),于产后0~96周定期随访检测查免疫功能、病毒载量和肝肾功能,分析早期HAART对产后妇女病毒清除、免疫功能恢复和肝肾安全性的影响。结果两组HIV妇女产后CD4计数、CD4/CD8比值在24~96周比较,差异均有统计学意义(P<0.01);A组妇女CD4、CD4/CD8随着HAART时间在不断上升,自产后24周显著升高(P<0.05),72周后CD4/CD8平均值>1.0;B组CD4、CD4/CD8产后24周显著下降(P<0.01)。A组妇女随治疗时间延长,病毒清除率越高(RNA<20 copies/mL)(P<0.01);两组肾功能(TBIL和CREA)均值差异无统计学意义(P>0.05),但两组肝功能(ALT和AST)48~72周差异有统计学意义(P<0.05),A组ALT、AST不良事件发生率比B组低。结论早期HAART有利于无症状HIV妇女病毒清除和免疫功能重建、完善免疫细胞亚群比例,有较好肝肾功能安全性。Objective To explore the clinical efficacy and safety of early onset of highly active anti-AIDS retroviral therapy(HAART)in asymptomatic postpartum women with HIV infection.Methods A total of 104 asymptomatic HIV postpartum women with CD4 cells≥400/μL in Guangxi were selected.They received HIV prevention of mother-to-child transmission(PMTCT)during pregnancy and continued to receive HAART after delivery(52 patients in group A)or discontinued postpartum HAART treatment(52 patients in group B).Regular follow-ups were done postpartum 0~96 weeks to examine immune function,liver/kidney function and viral load and to analyze the effect of HAART on viral clearance,immune reconstitution,liver and kidney function in postpartum women.Results CD4 count and CD4/CD8 between the two groups from 24 to 96 weeks were significantly different(P<0.01).CD4 and CD4/CD8 significantly increased in group A(P<0.05).After 72 weeks,CD4/CD8 ratio of group A was reversed(mean CD4/CD8)≥1.0).In Group B,CD4 and CD4/CD8 decreased significantly at 24 weeks postpartum(P<0.01),and gradually decreased with time.Group A had a higher rate of viral suppression(RNA<20 copy/mL)with prolonged treat time(P<0.01).There was no significant difference(P>0.05)in renal function(TBIL and CREA)between the two groups;but there was statistically significant difference(P<0.05)in liver function(ALT and AST)from 48 to72 weeks that the levels of ALT and AST in group A were lower than those in group B and the AE of ALT and AST in group A was significantly lower than that in group B.Conclusion Early HAART is beneficial for virus removal and immune system reconstruction,promoting normal proportion of immune cell subpopulations.It is safe for liver and kidney in HIV asymptomatic women.

关 键 词：早期HAART HIV育龄妇女 CD4/CD8 病毒载量 肝肾功能 

分 类 号：R512.91[医药卫生—内科学]