目的 分析HBV/HCV共感染对HIV/AIDS患者依非韦伦血药浓度、临床疗效及主要肝功能生化指标的影响,以明确依非韦伦血药浓度、肝毒性及共感染三者间的相关关系。方法 采用PCR、流式细胞术、全自动生化分析及HPLC对494例采用替诺福韦、拉米夫定联合依非韦伦治疗方案的单纯HIV感染、HIV/HBV、HIV/HCV共感染者外周血的HIV RNA病毒载量、CD4+ T细胞、肝功能生化指标及依非韦伦血药浓度进行检测分析。结果 治疗48周时,单纯HIV感染、HIV/HBV、HIV/HCV组依非韦伦血药浓度分别为3.781 mg·L-1(3.012~4.980 mg·L-1)、3.057 mg·L-1(2.040~5.144 mg·L-1)、2.557 mg·L-1(2.212~4.334 mg·L-1)(P<0.05),病毒学部分及完全抑制的比例分别为78.59%、76.36%和100.00%,CD4细胞计数分别从基线的(290±118)、(273±120)和(282±134) cells·mm-3上升到了48周的(442±184)、(457±221)和(391±151) cells·mm-3(P<0.05),肝功能生化指标总体保持在正常范围内,且三组间无统计学差异。结论 入组的绝大多数患者免疫重建顺利,疗效理想。HBV/HCV共感染不会导致依非韦伦在HIV/AIDS患者体内蓄积,对肝功能生化指标也未见显著影响。HIV/HBV、HIV/HCV初治患者服用依非韦伦安全有效。
Abstract
OBJECTIVE To investigate the influence of HBV and HCV co-infection on the plasma concentrations, efficacy and hepatotoxicity of efavirenz in HIV/AIDS patients. METHODS The peripheral blood HIV RNA viral loads, CD4+ T-cells, liver function and plasma efavirenz concentrations of 494 cases of HIV monoinfected, HIV/HBV and HIV/HCV co-infected patients were determined by PCR, flow cytometry, automatic biochemical analysis and HPLC and statically compared. RESULTS The median (IQR) efavirenz concentrations at week 48 of HIV-monoinfected patients, HBV- and HCV-coinfected patients were 3.781 mg·L-1(3.012-4.980 mg·L-1), 3.057 mg·L-1(2.040-5.144 mg·L-1), 2.557 mg·L-1(2.212-4.334 mg·L-1), respectively (P<0.05), while the proportions of patients achieving partial and complete virus inhibition were 78.59%, 76.36%, and 100.00%, respectively. The mean±SD CD4 cell counts steadily increased over time from (290±118), (273±120), and (282±134)cells·mm-3 at baseline to (442±184), (457±221), and (391±151) cells·mm-3 at week 48, respectively(P<0.05). The indexes of liver functions were all basically within normal limits. CONCLUSION The immune reconstruction of most patients is smooth and they also have favorable prognosis. Co-infection with HBV or HCV will not cause accumulation of efavirenz or hepatic damage. Efavirenz is safe and effective for treatment-naive HIV/AIDS patients with HBV and HCV co-infection.
关键词
共感染 /
依非韦伦 /
血药浓度 /
疗效 /
肝毒性
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Key words
co-infection /
efavirenz /
plasma concentration /
efficacy /
hepatotoxicity
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中图分类号：
R969.1
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参考文献
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脚注
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基金
十三五国家科技重大专项课题-艾滋病综合治疗方案的优化及推广应用研究项目资助(2017ZX10202101)
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