HIV职业暴露后洛匹那韦/利托那韦方案与拉替拉韦方案的效果和耐受性比较  

Comparison of efficacy andtolerability between lopinavir/litonavir based regimen and raltigravir based regimen after occupational exposure to HIV

作　　者：张美[1] 彭芳 汪雯[1] 李群辉[1] 任美欣[1] 张宏伟[1] ZHANG Mei;PENG Fang;WANG Wen;LI Qunhui;REN Meixin;ZHANG Hongwei(Department of Infection and Immunology,Beijing Youan Hospital,Capital Medical University,100069,China)

机构地区：[1]首都医科大学附属北京佑安医院感染与免疫医学科,100069 [2]宜春医学院第二附属医院感染科,336028

出　　处：《传染病信息》2023年第1期57-60,共4页Infectious Disease Information

基　　金：北京市医院管理中心人才培养计划“登峰”项目(DFL20191701)。

摘　　要：目的 探讨替诺福韦(tenofovir, TDF)+拉米夫定(lamivudine, 3TC)或恩曲他滨(emtricitabine, FTC)+洛匹那韦/利托那韦(lopinavir/litonavir, LPV/r)方案(简称LPV/r方案)与TDF/FTC+拉替拉韦(raltegravir, RAL)方案(简称RAL方案)在HIV职业暴露后预防中的效果和不良反应。方法 收集我院2015年1月1日─2020年12月31日217例HIV职业暴露人员的临床资料,回顾性分析LPV/r方案和RAL方案在预防效果和不良反应方面的差异。结果 在217例HIV职业暴露人员中,采用LPV/r方案(LPV/r方案组)共37例(17.1%),采用RAL方案(RAL方案组)共180例(82.9%)。其中,LPV/r方案组与RAL方案组患者在性别、年龄、职业、平均工作年限、暴露方式、暴露源危险度及服药时间方面比较,差异均无统计学意义(P均>0.05)。LPV/r方案组用药依从性>95%者有34例(91.9%),明显低于RAL方案组的178例(98.9%)(P<0.05)。LPV/r方案组腹泻、腹痛、恶心/呕吐的发生率分别为27.0%、18.9%、35.1%,均明显高于RAL方案组的8.3%、6.7%、12.2%(P均<0.05)。2组均无HIV抗体转阳患者。结论 LPV/r方案和RAL方案均具有良好的预防效果,但RAL方案具有更好的用药依从性和耐受性,在HIV职业暴露时应根据具体情况选择用药。Objective To explore efficacy and adverse events of tenofovir(TDF) + lamivudine(3TC) or emtricitabine(FTC) +lopinavir/ritonavir(LPV/r) regimen(LPV/r based regimen for short) and TDF/FTC + raltigravir(RAL) regimen(RAL based regimen for short) in post-exposure prophylaxis following occupational exposure to HIV. Methods Clinical data about 217 cases of occupational exposure to HIV were collected in our hospital from January 1, 2015 to December 31, 2020. The differences inefficacy and adverse events between the LPV/r based regimen and RAL based regimen were retrospectively analyzed. Results Among 217 cases of HIV occupational exposure, 37 cases(17.1%) used the LPV/r based regimen and 180 cases(82.9%) used the RAL based regimen. There were no significant differences between the 2 groups in terms of gender, age, occupation, working years, exposure mode, risk of exposure sourceand and medication time(P >0.05). There were 34 cases(91.9%) with drug compliance > 95% in the LPV/r based regimen group, which was significantly lower than 178 cases(98.9%) in the RAL based regimen group(P <0.05). The incidence of diarrhea,abdominal pain and nausea/vomiting in the LPV/r based regimen group was 27.0%, 18.9% and 35.1%, respectively, which was significantly higher than that in RAL based regimen group(8.3%, 6.7% and 12.2%, P <0.05). There were no HIV antibody positive patients in both groups. Conclusions Both the LPV/r based regimen and the RAL based regimen have good preventive effects, but the RAL based regimen has better drug compliance and tolerance. The regimen should be selected according to the specific situation during occupational exposure to HIV.

关 键 词：HIV 职业暴露 药物依从性 不良反应 暴露后预防 抗病毒药物 血清学转换 安全性 

分 类 号：R512.91[医药卫生—内科学]