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目的评估艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)一线抗病毒治疗(ART)失败后,各抗病毒治疗药物的耐药情况,更换为含有克力芝(LPV/r)抗病毒治疗方案后的疗效以及影响疗效的因素分析。方法采用回顾性队列分析的方法,对国家免费抗病毒治疗信息系统中,云南省一线治疗失败、有耐药检测结果、更换为含克力芝的二线方案,并至少接受二线治疗3个月以上的HIV/AIDS病人进行分析。所有的统计分析都使用SAS 9.2完成。结果共入选1 312例病人,其中男性812例,占61.9%,女性500例,占38.1%,平均年龄(36.19±10.36)岁。更换含LPV/r的二线方案后,6个月至48个月病毒抑制率达到73.7%~82.1%。单因素分析发现,使用替诺福韦+拉米夫定+LVP/r、启动ART 12个月后发生病毒学失败、治疗失败后病毒载量(VL)<5 000拷贝/mL,这三项指标对病毒抑制率的影响有统计学意义。多变量分析也显示,更换方案后12个月,VL的抑制率与这三项指标和更换方案时CD4~+T淋巴细胞计数水平有关。结论一线抗病毒药物治疗失败之后更换含LPV/r的二线方案,可以取得较好的治疗效果。为了获得较好的二线药物治疗效果,在发现病毒学失败后应加强依从性教育,3个月内复查病毒载量,若2次VL≥1 000拷贝/mL应尽早更换标准二线治疗方案。
Objective To assess the resistance of first-line antiviral therapy (ART) to HIV-infected / AIDS patients (referred to as HIV / AIDS patients) and replace with anti-viral drugs / r) efficacy after antiviral treatment and analysis of the factors influencing efficacy. Methods Retrospective cohort analysis was used in the free antiviral treatment information system in the country. First-line treatment failed and drug resistance test results in Yunnan Province were changed to the second-line regimen with Creutzfeldt-Jakob disease and at least three months after second-line treatment Of HIV / AIDS patients were analyzed. All statistical analysis is done using SAS 9.2. Results A total of 1 312 patients were enrolled, including 812 males (61.9%) and 500 females (38.1%), with an average age of 36.19 ± 10.36 years. After replacing the second-line program with LPV / r, the virus inhibition rate reached 73.7% ~ 82.1% from 6 months to 48 months. Univariate analysis found virologic failure after 12 months of initiation of ART with tenofovir + lamivudine + LVP / r and viral load (VL) <5 000 copies / mL after treatment failure The impact of indicators on the virus inhibition rate was statistically significant. Multivariate analysis also showed that at 12 months after the regimen was changed, the inhibition rate of VL was related to the level of CD4 ~ + T lymphocyte counts in the three indicators and the replacement regimen. Conclusion The replacement of the second-line regimen containing LPV / r after first-line antiviral therapy fails can achieve better therapeutic effect. In order to obtain a better second-line drug treatment, we should strengthen the education of compliance after finding the virological failure and review the viral load within 3 months. If the second VL≥1 000 copies / mL, the standard second-line treatment should be replaced as soon as possible.