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目的评价云南省艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(HIV/AIDS病人)早期抗反转录病毒治疗(ART)的有效性和安全性。方法对云南省2011年8月至2012年8月期间开始ART的病人,按照基线CD+4T淋巴细胞(CD4细胞)计数水平分A、B两组,A组为基线CD4细胞计数>350/μL的病人(早期治疗组),B组为基线CD4细胞计数≤350/μL的病人(延迟治疗组)。比较两组病人治疗满1年后的队列保持情况、治疗效果、治疗期间病人的不良反应和机会性感染发生等情况。结果两组9810例病人治疗满1年后,在队列保持方面,A组病人坚持治疗的比例(在治率)为88.0%(1712/1946),高于B组的84.9%(6674/7864);死亡率A组(1.2%)低于B组(5.7%);在治疗效果方面,两组的HIV病毒载量抑制比例差异无统计学意义(P>0.05),两组病人中,HIV病毒载量<400拷贝/mL病人所占比例,分别为90.4%和91.2%;治疗6个月和12个月时,与基线CD4细胞计数相比,A组的增幅(4.32%)(治疗前后CD4细胞差值的比较)低于B组(10.27%),P<0.01,但A组病人仍然获得比B组较高的CD4细胞平均值;在机会性感染和不良反应方面,A组的发生比例(4.3%和20.9%)均低于B组(10.3%和24.3%),P<0.01。结论云南省HIV/AIDS病人早期治疗12个月能够获得良好的有效性和安全性,初步实现了减少HIV相关的发病率和死亡率、非艾滋病相关疾病的发病率和死亡率和改善生活质量的抗病毒治疗总体目标。
Objective To evaluate the efficacy and safety of early antiretroviral therapy (ART) in HIV-infected / AIDS patients (HIV / AIDS patients) in Yunnan Province. Methods Patients with ART who started ART between August 2011 and August 2012 in Yunnan Province were divided into groups A and B according to the baseline CD + 4T lymphocyte (CD4) count. Group A had a baseline CD4 count> 350 / μL (Early treatment group) and group B patients (baseline treatment) with a baseline CD4 count ≤350 / μL (delayed treatment group). The cohort maintenance, treatment effect, patients’ adverse reactions and opportunistic infections during the treatment were compared between the two groups. Results In the cohort of 9810 patients after treatment for one year, the percentage of adherence to treatment in group A was 88.0% (1712/1946), which was higher than 84.9% (6674/7864) in group B, ; The death rate in group A (1.2%) was lower than that in group B (5.7%); in the treatment effect, there was no significant difference in the proportion of HIV viral load between the two groups (P> 0.05) The percentages of patients with <400 copies / mL load were 90.4% and 91.2%, respectively; at 6 and 12 months of treatment, the increase in group A (4.32%) compared to baseline CD4 cell count Cell difference) was lower than that in group B (10.27%), P <0.01, but the average CD4 cell count in group A was still higher than that in group B. In terms of opportunistic infections and adverse reactions, the incidence of group A (4.3% and 20.9%) were lower than those in group B (10.3% and 24.3% respectively), P <0.01. Conclusions Early treatment of HIV / AIDS patients in Yunnan Province can achieve good efficacy and safety at 12 months of treatment, and initially achieve the goal of reducing HIV-related morbidity and mortality, morbidity and mortality of non-AIDS-related diseases and improving quality of life Antiviral therapy overall goal.