上海地区艾滋病患者初始一线抗反转录病毒治疗药物更换原因的比较研究

目的对上海地区接受国家免费抗病毒初始治疗艾滋病患者各种治疗药物更换的时间、原因及例次频率进行研究,从而比较各种药物的耐受性的差异。方法回顾性分析1 154例接受抗反转录病毒治疗(ART)艾滋病患者初始治疗方案中每种药物在开始使用后的不同时间段内被更换的最常见原因以及发生更换的例次频率。结果启动ART后的3个月内更换治疗药物的原因以奈韦拉平(NVP)导致的严重皮疹、依非韦伦(EFV)导致的严重皮疹和齐多夫定(AZT)导致的中性粒细胞(ANC)<0.75×109/L为主。随着治疗时间的延长因AZT导致的严重贫血、NVP导致的肝毒性更换药物的患者增多。治疗超过1年后患者更换药物的原因多集中于司他夫定(d4T)所致的外周神经损害、脂肪萎缩、血脂异常以及发生治疗失败。因各种原因更换药物共352例次,其中严重的药物不良反应为302例次(26.17%),治疗失败为50例次(4.33%)。d4T治疗满1年后因血脂异常、脂肪萎缩及治疗失败发生更换药物的例次频率逐渐增加;AZT的更换原因主要为重度骨髓抑制,发生的时间主要集中在开始ART后的6个月内;EFV更换的例次较少;NVP更换主要原因为严重皮疹和3级以上肝毒性,在开始治疗后的1个月内发生频率较高。结论在ART过程中,患者接受治疗的时间长短不同,发生的药物不良反应也不相同。部分药物不良反应发生的时间范围较大。不良反应仍是影响患者依从性、抗病毒疗效的主要原因。

Analysis of the causes of switching first-line antiretroviral agents in treatment- naive HIV/AIDS patients in Shanghai

Objective To compare the tolerability of a variety of antiretroviral agents by analyzing the time to, cause and frequency of treatment switch in treatment-naive HIV/AIDS patients receiving national free antiretroviral treatment in Shanghai. Methods This retrospective analysis was conducted in 1 154 patients receiving anti-retroviral therapy （ART） to compare the most common causes and frequency of switching each antiretroviral agent at different time period since the start of ART. Re- sults Within 3 months since the initiation of ART, the most common causes of treatment switch included： nevirapine due to severe rashes, efavirenz due to serious rashes and zidovudine due to ANC 〈 0.75 × 10^9/L. Beyond 3 months of treatment, more patients discontinued zidovudine due to severe anemia, or switched off nevirapine due to liver toxicity. After ART for 1 year, treatment switch was mostly due to d4T-induced peripheral neuropathy, fat redistribution, dyslipidemia and treatment failure. A total of 352 episodes of treatment switch occurred for various reasons. There were 302 （26. 17%） episodes of serious adverse drug reactions. Treatment failure was documented in 50 （4.33%） patients. After d4T treatment for 1 year, the frequency of treatment switch due to dyslipidemia, fat redistribution, and treatment failure increased. Zidovudine switch-off was mainly due to severe bone marrow suppression, mostly within 6 months after ART. Switch treatment of efavirenz was infrequent. Discontinuation of nevirapine was mainly due to serious rash and Grade 3 hepatotoxicity; mostly within a month after ART. Conclusions The type and frequency of adverse drug reaction varies with the duration of ART. Some adverse drug reactions occur in a wide range of time period. Adverse drug reaction is still a key factor affecting the compliance and efficacy of ART.