Retrospective Study Of Changing HAART Programs For HIV/AIDS Patients

ObjectiveThrough inquiry of medical records,investigatning and analyzing the situation of changing treatment plan and non-changing treatment plan of HIV/AIDS patients in an AIDS antiretroviral treatment point in Dali,and suming up the reasons and conditions of changing treatment plan.And inquiry and retrospective analysis of the existence of two causes,the status of HCV infection and treatment and HALS in HIV/AIDS patients was analyzed,and severe HALS patients'tissue slices were made to analyze the tissue layers and cell structure characteristics of adipose malnutrition,so as to provide a basis for the prevention and treatment of adipose malnutrition.MethodsThe subjects were divided into two groups according to whether to change the treatment plan or not,and the basic demographic information,treatment information and follow-up information of the subjects were collected for statistical analysis.According to HCV antibody,the positive persons were included in the HIV combined with HCV infection group?HIV/HCV group?,the negative persons were included in the HIV single infection group?HIV group?,and the related datas were collected for statistical analysis.Patients diagnosed as HALS by clinicians,patients'self-identification and measurement methods.The related datas were collected for statistical analysis.And obtaining informed consent of patients with severe fat malnutrition?cheek atrophy depression more than 0.5cm,limbs thinning or abdominal fat deposition?,then taking tissue from the fat malnutrition site to make tissue sections.Result40.4%?538/1331?of the HIV/AIDS patients had changed the treatment regimen,of which64.7%had changed once,24.7%had changed twice,8.4%had changed three times,and 2.2%had changed more than three times.The mortality rate of patients who had changed treatment regimen was higher than that of patients who had not changed.Drug replacement ratio from big to small was d4T>AZT>TDF;NVP>EFV and LPV/r.The main reasons for the replacement were myelosuppress?21.9%?,followed by abnormal fat distribution?12.5%?,abnormal liver function?11.8%?,peripheral neuritis?11.5%?,erythra?9.5%?,hepatitis C treatment?8.2%?,other adverse reactions?6.5%?,treatment failure?6.0%?,others?5.1%?,central nervous system symptoms?5.0%?and gastrointestinal tract adverse reactions?2.0%?.The baseline CD₄ cell count of most patients changed treatment regimen for erythra were more than 200 cells/?L,which was different from those with peripheral neuritis,myelosuppress,abnormal fat distribution and abnormal liver function.Infection route,treatment time and baseline CD₄ cells count were the factors influencing the replacement therapy.HCV infection accounted for 40.3%of HIV/AIDS patients,and the main route of HCV infection was intravenous drug abuse?88.0%?.The main change of AIDS epidemic in Dali is that injection drug abuse changed to be sexually transmitted.HIV/HCV infection did not affect the antiviral treatment effect of HIV?increased CD₄⁺T cell count?,but the mortality rate of HIV/HCV infection increased.There was no significant abnormality of liver function in HIV-infected patients,but the liver function damage was obvious in HIV-infected patients with HCV infection.After HAART and anti-HCV treatment,the abnormal indexes of liver function recovered,and the non-invasive indexes reflecting the liver fibrosis and cirrhosis,the proportion of patients with APRI score>2,FIB-4 index>3.25 decreased,and there was no difference with the single infection group,and the improvement of liver function damage was obvious.HALS was found in 16.3%?217/1331?of HIV/AIDS patients at the treatment site,and 33.6%of them triglycerides increased slightly?2.3⁵.65 mmol/L?and 8.8%increased severely?>5.65 mmol/L?,Other blood routine and biochemical indexes were not abnormal within the normal reference range.Facial tissue specimens were taken from 7 patients with facial fat atrophy,and leg and left hand tissue specimens were taken from 2 patients with limb fat atrophy,6/9 patients had adipose tissue in dermis,5/9 of HIV/AIDS patients had infiltration of small blood vessels or perisebaceous inflammatory cells in dermis,2/9 patients had sebaceous gland hyperplasia,epidermal atrophy or local defect,and some had local hemorrhage,hyalinization of dermal fibrous tissue.Conclusion1.In the study,40.4%of HIV/AIDS patients in the AIDS antiviral treatment point changed their treatment regimen,mainly because of bone marrow suppression,fat malnutrition,abnormal liver function,peripheral neuritis,rash,hepatitis C treatment,etc.2.HIV/AIDS patients with drug abuse and low baseline CD₄ cells have a higher probability of changing treatment regimens,and Clinicians should pay attention to these patients and formulate a more appropriate initial treatment regimen for them so as to avoid changing treatment regimens as far as possible.The probability of changing the treatment plan increases with the increase of treatment time,which should be paid close attention in the follow-up process.3.HCV co-infection in 40.3%of HIV/AIDS patients in this treatment point,co-infection does not affect the therapeutic effect of HAART.The anti-viral treatment rate of HCV in co-infected patients is low,and most of the untreated patients have replication of HCV virus,anti-viral treatment of HAART and HCV is helpful to improve liver function damage,it is suggested that relevant departments pay attention to the treatment of hepatitis C patients.4.HALS was found in 16.3%of HIV/AIDS patients in this study,and increased abnormal rate of plasma triglycerides in patients with HALS.HE staining of adipose atrophic tissue sections in HALS patients was characterized by visible adipose tissue and infiltration of small vessels or perisebaceous inflammatory cells in the dermis,suggesting that HALS patients could be prevented and treated from the perspective of adjusting fat distribution and egulating local immune function...