晚发现老年HIV-1感染者抗逆转录病毒治疗优化探索  

Optimization of anti-retroviral therapy for lately diagnozed HIV-1 infected elderly patients

作　　者：何沅鸿 刘欢霞 何盛华 杨彤彤 He Yuanhong;Liu Huanxia;He Shenghua;Yang Tongtong(Infectious Disease Department,Chengdu Public Health Clinical Medical Center,Chengdu 610061,China)

机构地区：[1]成都市公共卫生临床医疗中心感染一科,610061

出　　处：《国际病毒学杂志》2024年第6期457-461,共5页International Journal of Virology

基　　金：四川省临床重点专科建设项目(2023AGRKP001);成都市卫生健康委员会课题(2023094);中华医学会科研课题(CMAPH-NRD2021058)。

摘　　要：目的探索晚发现老年HIV-1感染者(people living with HIV-1,PLWH)的抗逆转录病毒治疗(antiretroviral therapy,ART)优化方案。方法回顾性收集了2020年9月—2022年9月期间,使用注射用艾博韦泰(albuvirtide,ABT)联合多替拉韦(dolutegravir,DTG)或拉米夫定多替拉韦(lamivudine and dolutegravir,DTG/3TC)方案进行持续治疗24周及以上、年龄≥50岁的晚发现PLWH的病例资料,采用广义估计方程分析ART疗效,参照DAIDS不良事件分级表评估不良事件。结果纳入56例符合条件的晚发现老年PLWH,均合并严重机会性感染,58.93%合并机会性感染≥2种,66.07%患者WHO临床分期为IV期。56例患者基线HIV-1 RNA 5.40(4.92,5.71)lg copies/mL,CD477.00(43.00,143.50)cells/μL。ART 4周、12周、24周HIV-1 RNA较基线分别下降(3.23±0.11)、(3.75±0.08)、(4.55±0.12)lg copies/mL(P均<0.01),CD4分别上升(54.59±11.56)、(112.34±13.34)、(115.14±13.91)cells/μL(P均<0.01)。ART 4周、12周、24周病毒学抑制(HIV-1 RNA<50 copies/mL)率分别为26.53%、46.43%、78.57%。24周治疗期间无患者发生注射位点反应,1~2级不良事件总发生率69.64%,3级不良事件总发生率17.86%;与ART药物相关的1~2级不良事件发生率7.14%,严重不良事件总发生率17.86%,未发生与ART药物相关的严重不良事件。亚组分析:ABT+DTG与ABT+DTG/3TC相比,疗效和安全性差异无统计学意义(P>0.05)。结论ABT+DTG或ABT+DTG/3TC用于晚发现老年PLWH能快速降低HIV-1 RNA和升高CD4,治疗24周取得较高的病毒学抑制率和免疫应答,安全性良好。Objective To explore the optimized regimen of antiretroviral therapy(ART)among late diagnosed elderly people living with HIV-1(PLWH).Methods The data of late diagnosed PLWH who were aged 50 years and over,received continuous combined therapy of intravenous injection of albuvirtide(ABT)with dolutegravir(DTG)or lamivudine and dolutegravir therapy(DTG/3TC)for 24 weeks or longer between September 2020 and September 2022 were collected retrospectively.Generalized Estimating Equations were used to analyze the effectiveness of ART.Adverse events were assessed based on DAIDS adverse events grading table.Results Fifty-six eligible PLWH were enrolled in the study.All patients had severe opportunistic infections while 58.93%of them had 2 or more opportunistic infections and 66.07%were at WHO clinical stage 4.The baseline HIV-1 RNA of the 56 PWH was 5.40(4.92,5.71)log10 copies/ml and CD4 count was 77.00(43.00,143.50)cells/μl.Comparing to the baseline value,HIV-1 RNA titers dropped 3.23±0.11,3.75±0.08 and 4.55±0.12 log10copies/ml at 4,12 and 24 weeks of ART,respectively(all P values<0.001)while CD4 increased(54.59±11.56),(112.34±13.34)and(115.14±13.91)cells/μl,respectively(all P values<0.001).The HIV-1 virological suppression rates(HIV-1 RNA<50 copies/ml)at 4,12 and 24 weeks of ART were 26.53%,46.43% and 78.57%,respectively.During the 24 weeks treatment,no patients had adverse reaction at injection site.The overall incidence of grade 1 and 2 adverse events was 69.64%while the incidence of grade 3 events was 17.86%.For the adverse events related to ART drugs,the overall incidence was only 7.14% and no severe adverse event.In the subgroup analyses,the difference in effectiveness and safety between ABT+DTG and ABT+DTG/3TC was not statistically significant(P>0.05).Conclusions For the treatment of late diagnosed elderly PLWH,ABT+DTG or ABT+DTG/3TC can rapidly decrease HIV-1 RNA titer and increase CD4 count.The 24-weeks treatment achieved high virological suppression rate and immune response with good safety.

关 键 词：老年HIV-1感染者 抗逆转录病毒治疗 疗效 安全性 

分 类 号：R51[医药卫生—内科学]