Early outcome of second line antiretroviral therapy in treatment-experienced human immunodeficiency virus positive patients.
Early outcome of second line antiretroviral therapy in treatment-experienced human immunodeficiency virus positive patients.
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DOI：
10.4103/2229-3485.120170
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发表时间：
2013-10
影响因子：
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通讯作者：
Dikshit RK
中科院分区：
文献类型：
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作者：
Patel D;Desai M;Shah AN;Dikshit RK
治疗经验丰富的人类免疫缺陷病毒（HIV）患者的多药耐药性一直是一线抗逆转录病毒治疗（ART）失败的主要原因，需要转换到二线治疗。在印度，二线治疗方案仍然相对较新，经验不足，结果不明确。因此，在公共部门三级护理中心转换为二线抗逆转录病毒治疗的患者中，评估第一年随访的临床、病毒学和免疫学有效性以及治疗结果至关重要。2010年1月至2010年12月，在阿赫梅达巴德民用医院抗逆转录病毒治疗中心，对转为二线抗逆转录病毒治疗的艾滋病毒阳性患者进行了一项前瞻性观察性研究。在病例记录表中记录人口统计学详情、症状、药物不良反应（ADR）、二线ART方案、CD 4计数和血浆病毒载量（PVL）。患者每月随访12个月。采用t检验、z检验和Fisher精确检验对数据进行分析。在126例患者中，82例接受V方案[齐多夫定（ZDV）+拉米夫定（3 TC）+替诺福韦（TDF）+加强的洛匹那韦（LPV/r）]，44例接受Va方案[3 TC + TDF + LPV/r]。显著（P < 0.0001）在二线ART治疗12个月时观察到平均体重增加和WHO III/IV期患者数量显著减少（7例）。此外，显著的免疫重建，平均CD 4计数增加和病毒抑制PVL < 400拷贝/ml者103例（82%），P < 0.0001。在69例（55%）患者中共观察到83例ADR，最常见的是血脂异常（57例），其次是贫血（9例）。二线抗逆转录病毒疗法的早期治疗结果良好，治疗经验丰富的艾滋病毒患者的成功率为82%。血脂异常和贫血是观察到的常见ADR。
Multi-drug resistance in treatment-experienced human immune deficiency virus (HIV) patients has been a major cause to first line antiretroviral therapy (ART) failure, necessitating a switch to second line therapy. In India, the second line treatment program is still relatively new with little experience and unclear outcomes. It is therefore, critical to assess the clinical, virological and immunological effectiveness and treatment outcome over the 1st year of follow-up in the patients’ switched to the second line ART at public sector tertiary care center. A prospective, observational study was carried out on HIV positive patients switched on second line ART from January 2010 to December 2010 at ART Centre, Civil Hospital, Ahmedabad. Demographic details, symptoms, adverse drug reactions (ADRs), second line ART regimens, CD4 count, and plasma viral load (PVL) were recorded in a case record form. Patients were followed-up monthly for 12 months. The data was analyzed by t-test, z-test, and Fisher-exact test. Out of 126 patients, 82 received regimen V [zidovudine (ZDV) + lamivudine (3TC) + tenofovir (TDF) + boosted lopinavir (LPV/r)] and 44 received regimen Va [3TC + TDF + LPV/r]. A significant (P < 0.0001) increase in mean body weight and marked reduction in number of patients (7) categorized as WHO stage III/IV was observed at 12 months of second line ART. Moreover, a significant immune reconstitution with increase in mean CD4 count and viral suppression (PVL < 400 copies/ml) in 103 (82%) patients (P < 0.0001) was also observed. A total of 83 ADRs were observed in 69 (55%) patients, the most common being dyslipidemia (57) followed by anemia (9). Early treatment outcome with second line ART was good with 82% success rate in treatment experienced HIV patients. Dyslipidemia and anemia were the common ADRs observed.