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目的了解湖南省开展艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)高效抗反转录病毒治疗(HAART)的疗效、不良反应及耐药等情况。方法采用回顾性研究,对湖南省2003年9月至2012年12月间接受HAART的病例进行分析。结果共有6558例HIV/AIDS病人接受了HAART:1)CD+4T淋巴细胞(简称CD4细胞)计数随治疗时间的延长明显升高,按照基线CD4细胞水平划分为≤99个/μL、100~199个/μL、200~350个/μL三组,然后做两两比较,差异有统计学意义(P<0.01)。2)在治疗后7-12个月,64%的病人体内病毒复制得到了完全抑制,病毒载量检测值<50拷贝/mL;在治疗后7-12个月,病毒载量<50拷贝/mL的比例及病毒载量常用对数值lgVL变化幅度最大,12个月以后下降趋势减缓,约3年后进入平台期。3)服药后较常见的不良反应是胃口改变、恶心呕吐、皮疹及疲倦等,因不良反应更换治疗方案的病例占总换药病例的70.1%(1719/2451),因不良反应停药占总停药病例的33.6%(178/529)。4)最近一次病毒载量检测<50拷贝/mL的2739例病人中,连续2次CD4细胞计数较基线水平增幅<20%,或治疗一年以上未达200个/μL的共375例,免疫无应答比例13.7%。5)2011及2012连续两年耐药监测显示,总耐药率为2.6%,处于较低水平。结论湖南省艾滋病HAART在免疫学和病毒学方面均取得了较好的疗效,需进一步加强不良反应、免疫无应答及耐药情况的监测和处理。
Objective To understand the efficacy, adverse reactions and drug resistance of highly effective antiretroviral therapy (HAART) in Hunan Province for HIV / AIDS patients. Methods A retrospective study was conducted to analyze the cases of HAART between September 2003 and December 2012 in Hunan Province. Results A total of 6558 cases of HIV / AIDS patients received HAART: 1) The count of CD + 4T lymphocytes (CD4 cells for short) was significantly increased with the prolongation of treatment time. According to the baseline CD4 cell level, they were divided into ≤99 cells / μL and 100 ~ 199 A / μL, 200 ~ 350 / μL three groups, and then make any pairwise comparison, the difference was statistically significant (P <0.01). 2) At 7-12 months after treatment, viral replication was completely inhibited in 64% of patients, with a viral load of <50 copies / mL; in the 7-12 months after treatment, the viral load was <50 copies / mL ratio and viral load lgVL common logarithmic maximum range of change, 12 months later, the downward trend slowed down, about 3 years after entering the platform. 3) The most common adverse reactions after taking medicine were appetite changes, nausea and vomiting, rashes and tiredness, etc. The patients who changed treatment programs due to adverse reactions accounted for 70.1% (1719/2451) of the total dressing change cases, and discontinued due to adverse reactions accounted for 33.6% of cases discontinued (178/529). 4) Of the 2739 patients who had a recent viral load test <50 copies / mL, two consecutive CD4 cell counts increased by <20% from baseline or 375 were treated for more than one year in less than 200 cells / μL and were immunized No response rate of 13.7%. 5) Drug resistance surveillance in 2011 and 2012 showed that the total drug resistance rate was 2.6% at a relatively low level for two consecutive years. Conclusion HAART in Hunan Province has achieved good results in both immunology and virology. It is necessary to further strengthen the monitoring and management of adverse reactions, non-response to the immune response and drug resistance.