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目的了解在联合抗病毒治疗(ART)中病毒抑制但免疫失败的艾滋病(AIDS)病人,通过更换二线药方案后其免疫功能恢复情况,并对影响因素进行初步分析。方法按照纳入标准,选取了云南省免费抗病毒治疗的≥15岁青少年和成人AIDS病人的部分数据,回顾性分析CD4~+T淋巴细胞(简称CD4细胞)计数相较于换药前的变化情况。结果纳入分析的331例病人,启动ART时CD4细胞计数平均值是171.5个/mm~3(59.2%<200个/mm~3),更换含洛匹那韦/利托那韦的二线药方案前,CD4细胞计数平均值降低到125.3个/mm~3(86.4%<200个/mm~3),更换后CD4细胞计数增加到200个/mm~3以上。其中换药后第12、18、24、30、36、42和48个月,CD4细胞计数增加的平均值(个/mm~3)和[95%可信区间(CI)]分别为102.5(83.0,122.1)、123.0(95.9,150.2)、140.4(101.9,178.9)、145.6(96.0,195.2)、125.4(53.2,197.5)、179.9(96.0,263.8)和236.0(37.9,434.1)个/mm~3。以更换二线药前的CD4细胞计数作为协变量分析,启动ART时年龄≤50岁与>50岁的比较,CD4细胞计数增加的平均值(个/mm~3)和(95%CI)是65.8(17.61,113.92),计数增加的差异有统计学意义(P=0.008);启动ART时CD4细胞计数≤50个/mm~3组和50~100个/mm~3组分别与>200个/mm~3组比较,CD4细胞计数增加的平均值(个/mm~3)和(95%CI)分别是-120.0(-192.31,-47.76)和-73.3(-143.56,-3.07),计数增加的差异均有统计学差异(P=0.001和P=0.041)。结论更换洛匹那韦/利托那韦的二线药方案,可以使病毒抑制但免疫失败的艾滋病病人的CD4细胞计数增加;启动ART时≤50岁者,其CD4细胞计数增加的程度大于年龄更大的病例;启动ART时CD4细胞>200个/mm~3的病例,换药后CD4细胞计数增加的程度大于初始时CD4细胞≤100个/mm~3者。
Objective To understand the immune function recovery after the second-line drug replacement in HIV patients with virus-suppressed but immunocompromised virus in combined antiviral therapy (ART), and to analyze the influential factors. Methods According to the inclusion criteria, some data of AIDS patients aged 15 and over in free antiviral therapy in Yunnan Province were selected. The counts of CD4 ~ + T lymphocytes (CD4 cells) were compared retrospectively with those before dressing change . Results The 331 patients enrolled in the analysis had an average CD4 cell count of 171.5 / mm3 (59.2% <200 / mm3) at the start of ART, replacing the second-line regimen with lopinavir / ritonavir Before, the average value of CD4 cell count decreased to 125.3 / mm ~ 3 (86.4% <200 个 / mm ~ 3), after replacement CD4 cell count increased to 200 / mm ~ 3 above. The mean increase in CD4 count (a / mm ~ 3) and [95% confidence interval (CI)] at the 12th, 18th, 24th, 30th, 36th, 42th and 48th month after drug dressing were 102.5 123.0 (95.9,150.2), 140.4 (101.9,178.9), 145.6 (96.0,195.2), 125.4 (53.2,197.5), 179.9 (96.0,263.8) and 236.0 (37.9,434.1) / mm ~ 3. Using CD4 cell counts before second-line drug replacement as a covariate, the mean CD4 counts (a / mm3) and (95% CI) for ART at age 50 years and 50 years at ART initiation were 65.8 (17.61,113.92), the difference was statistically significant (P = 0.008); CD4 count when starting ART ≤50 / mm ~ 3 groups and 50 ~ 100 / mm ~ mm ~ 3, and (95% CI) were -120.0 (-192.31, -47.76) and -73.3 (-143.56, -3.07) The differences were statistically significant (P = 0.001 and P = 0.041). Conclusions The second-line regimen of replacement of lopinavir / ritonavir increases the CD4 count of HIV-infected patients who have been virus-suppressed but failed to immunize. The CD4 count of patients ≤50 years of age at ART initiation is greater than age Large cases; When CD4 cells> 200 cells / mm ~ 3 were activated in ART, the CD4 cell count increased more than the initial CD4 cells ≤ 100 cells / mm ~ 3 after dressing change.