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目的探讨某AIDS治疗示范区3种高效抗反转录病毒疗法(HAART)的疗效,为进一步合理使用抗病毒治疗方案奠定基础。方法回顾性分析AIDS治疗示范区抗病毒治疗6个月以上的3种治疗方案:叠氮胸苷(AZT)+双脱氧肌苷(DDI)+奈韦拉平(NVP),拉米夫定(3TC)+司他夫定(D4T)+NVP.D4T+DDI+NVP。分别检测HIV RNA、CD4~+细胞、耐药位点,统计学分析采用t检验或四格表法检验。结果3种治疗方案中,抗病毒治疗前后HIV RNA的转阴率比较.AZT+ DDI+NVP组与3TC+D4T+NVP组差异无统计学意义(P>0.05),D4T+DDI+NVP组与AZT +DDI+NVP组差异有统计学意义(P<0.05);3组CD4~+T淋巴细胞计数在治疗前后差异有统计学意义(P<0.05);其中AZT+DDI+NVP组CD4~+T淋巴细胞计数为(100～350)×10~6/L,HIV RNA转阴率较其他各组差异有统计学意义(P<0.05);AZT+DDI+NVP组核苷类反转录酶抑制剂(NRTIs.AZT+DDI)发生的耐药位点是M41L、E44A、K70KR、D67N、L210W、T215Y、K219W等.属于高度耐药;非核苷类反转录酶抑制剂(NNRTIs,NVP)是A98G、V179H、Y181C、K103N、G190A等,属于高度耐药;3TC+D4T+NVP组NNRTIs(NVP)发生的耐药位点是Y181C,未见3TC突变位点。DDI+D4T+NVP组NNRTIs发生的耐药位点是Y181C;但以上各组均未发现对蛋白酶抑制剂(PIs)耐药位点。结论AZT+DDI+NVP与3TC+D4T+NVP组疗效优于DDI+D4T+ NVP组,可获得较好疗效。
Objective To explore the efficacy of three highly active antiretroviral therapies (HAART) in a AIDS treatment demonstration area, and lay a foundation for further rational use of antiviral therapy. Methods A retrospective analysis of three treatment regimens of antiretroviral therapy for more than 6 months in AIDS treatment demonstration areas: azithromycin (AZT) + dideoxyinosine (DDI) + nevirapine (NVP), lamivudine Stavudine (D4T) + NVP.D4T + DDI + NVP. HIV RNA, CD4 ~ + cells and drug-resistant sites were detected. Statistical analysis was performed using t-test or four-cell table. Results Compared with 3TC + D4T + NVP group, there was no significant difference (P> 0.05) between HIVT and DDI + NVP group and between D4T + DDI + NVP group and AZT + DDI + NVP group (P <0.05). There was significant difference in CD4 ~ + T lymphocyte count between the three groups before and after treatment (P <0.05) The lymphocyte count was (100-350) × 10 ~ 6 / L, the negative rate of HIV RNA was significantly different from other groups (P <0.05). The nucleoside reverse transcriptase inhibition of AZT + DDI + NVP group (NRTIs.AZT + DDI) were highly resistant to M41L, E44A, K70KR, D67N, L210W, T215Y, K219W, etc.Non-nucleoside reverse transcriptase inhibitors (NNRTIs, NVP) A98G, V179H, Y181C, K103N and G190A were all highly resistant. The resistance site of NNRTIs (NVP) in 3TC + D4T + NVP group was Y181C, and no 3TC mutation site was found. The resistant site of NNRTIs in DDI + D4T + NVP group was Y181C; however, no site of resistance to protease inhibitors (PIs) was found in the above groups. Conclusion The efficacy of AZT + DDI + NVP and 3TC + D4T + NVP is better than that of DDI + D4T + NVP.