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目的评价凉山州布拖县艾滋病早期抗病毒治疗的疗效。方法选择凉山州布拖县2012年1月1日—2013年12月31日开始艾滋病抗病毒治疗的患者1 037例,按照基线CD4+T淋巴细胞计数水平分为2组,早期治疗组为基线CD4+T淋巴细胞计数>350个/mm3的患者(A组,n=459),延迟治疗组为基线CD4+T淋巴细胞计数≤350个/mm3的患者(B组,n=578),比较两组患者治疗满18个月后,在队列保持情况、治疗效果、药物不良反应等情况。结果治疗18个月后,在队列保持方面,A组和B组坚持治疗的比例分别为64.7%(297/459)和55.4%(320/578),病死率分别为6.1%(28/459)、14.4%(83/578),差异均有统计学意义(P<0.001)。在治疗效果方面,进行了病毒载量检测的患者中,A组和B组病毒抑制(病毒载量<400 copies/m L)率分别为64.0%(190/297)、63.8%(204/320),差异无统计学意义(P>0.05)。与基线CD4+T淋巴细胞计数相比,A组和B组CD4+T淋巴细胞增长率分别为5.7%、37.5%,差异有统计学意义(P<0.001)。结论凉山州布拖县艾滋病早期抗病毒治疗在病毒学方面是有效的,但CD4+T淋巴细胞的增长低于延迟抗病毒治疗人群;早期抗病毒治疗未增加药物常见不良反应的风险,可降低患者的病死率。
Objective To evaluate the efficacy of early antiviral treatment of AIDS in Budu County, Liangshan Prefecture. Methods A total of 1 037 cases of AIDS antiviral treatment were started in Putuo County, Liangshan Prefecture from January 1, 2012 to December 31, 2013. The patients were divided into two groups according to the baseline CD4 + T lymphocyte count level. The early treatment group was baseline Patients in the CD4 + T lymphocyte count> 350 / mm3 (arm A, n = 459) and patients in the delayed treatment group had a baseline CD4 + T lymphocyte count <350 / mm3 (arm B, n = 578) Two groups of patients after 18 months of treatment, in the cohort to maintain the situation, the treatment effect, adverse drug reactions and so on. Results After 18 months of treatment, in the cohort, the adherence rates in group A and group B were 64.7% (297/459) and 55.4% (320/578), respectively, and the case fatality rates were 6.1% (28/459) , 14.4% (83/578) respectively, the differences were statistically significant (P <0.001). Among the patients treated with viral load, the rates of viral suppression (viral load <400 copies / mL) in groups A and B were 64.0% (190/297), 63.8% (204/320 ), The difference was not statistically significant (P> 0.05). Compared with baseline CD4 + T lymphocyte count, the rates of CD4 + T lymphocyte proliferation in group A and B were 5.7% and 37.5%, respectively, with significant difference (P <0.001). Conclusions The early antiviral treatment of AIDS in Budu County, Liangshan Prefecture is effective in virology, but the growth of CD4 + T lymphocytes is lower than that of patients with delayed antiviral therapy. Early antiviral therapy does not increase the risk of common adverse drug reactions and can reduce Patient’s mortality.