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目的分析广西≥50岁艾滋病病毒(HIV)感染病人采用不同初始治疗方案的疗效,为老年HIV感染病人的抗病毒治疗(ART)提供临床经验。方法将1 893例老年HIV感染病人分为3组,每组631例,分别用含洛匹那韦/利多那韦(LPV/r)、依非韦伦(EFV)、奈韦拉平(NVP)的标准三联方案进行初始治疗,分析比较3组的病毒学、免疫学效果。结果三组病人的基线特征中,性别差异有统计学意义(P=0.015),其他指标均无差异。12个月时,LPV/r组、EFV组、NVP组的病毒抑制率分别为82.17%、87.24%、80.04%,EFV组的病毒抑制率明显高于NVP和LPV/r组(P=0.006),是NVP组的1.71倍[95%可信区间(CI):1.22~2.38],LPV/r组的1.48倍(95%CI:1.06~2.08)。进一步分析发现,12个月时,LPV/r组与EFV组在病毒载量(VL)<400拷贝/mL及VL<1 000拷贝/mL水平的抑制率无差异(P>0.05),并且均高于NVP组(P<0.05)。随后LPV/r组、EFV组、NVP组的病毒抑制率在24个月时,分别为87.26%、86.06%、83.46%,在36个月时为93.30%、91.62%、90.03%,在48个月时为88.00%、90.59%、93.60%,3组间差异无统计学意义(P>0.05)。免疫学方面,治疗后6~42个月,3组间的CD4~+T淋巴细胞计数差异有统计学意义(P<0.05),LPV/r组显著高于NVP组和EFV组,而第48个月,3组间差异虽然无统计学意义(P=0.084),但LPV/r组的均值高于EFV和NVP组。结论含LPV/r、EFV、NVP的不同初治方案治疗老年HIV感染病人均获良好的疗效。含LPV/r的初治方案虽然在1年时的病毒抑制率低于EFV方案,但4年的长期病毒抑制率并无差别,在免疫学效果上的优势突出。
Objective To analyze the curative effect of different initial treatment programs on HIV-infected patients aged≥50 years in Guangxi and provide clinical experience for antiviral therapy (ART) in elderly HIV-infected patients. Methods A total of 1 893 HIV-infected elderly patients were divided into 3 groups, 631 in each group. The patients were divided into three groups according to the standard of LPV / r, EFV and NVP Triple program initial treatment, analysis and comparison of the three groups of virology, immunological effects. Results Among the baseline characteristics of three groups of patients, the gender difference was statistically significant (P = 0.015). There was no difference in other indexes. At 12 months, the virus inhibitory rates in LPV / r, EFV and NVP groups were 82.17%, 87.24% and 80.04%, respectively. The virus inhibition rates in EFV group were significantly higher than those in NVP and LPV / r groups (P = 0.006) , Which was 1.71 times [95% confidence interval (CI): 1.22-2.38] in the NVP group and 1.48 times (95% CI: 1.06-2.08) in the LPV / r group. Further analysis showed that there was no difference (P> 0.05) between LPV / r group and EFV group at viral load (VL) <400 copies / mL and VL <1000 copies / mL at 12 months Higher than NVP group (P <0.05). Then the virus inhibition rates of LPV / r group, EFV group and NVP group were 87.26%, 86.06% and 83.46% respectively at 24 months, 93.30%, 91.62% and 90.03% at 36 months, Month, 88.00%, 90.59%, 93.60%, there was no significant difference among the three groups (P> 0.05). Immunologically, CD4 ~ + T lymphocyte counts among the three groups differed significantly from 6 to 42 months after treatment (P <0.05), LPV / r group was significantly higher than NVP group and EFV group, and 48 There was no significant difference between the three groups for months (P = 0.084), but the mean of LPV / r group was higher than that of EFV and NVP groups. Conclusion Different treatment regimens including LPV / r, EFV and NVP have a good curative effect in the treatment of senile HIV infection. Although the initial regimen containing LPV / r at 1 year was lower than that of the EFV regimen, the 4-year long-term viral suppression rate did not differ and the immunological effect was superior.