| AIDS(acquiredimmunodeficiency syndrome, AIDS)is an infectious disease caused by HIV(human immunodeficiency virus, HIV),yet not completely cured. In the condition of limitied resources, the feasibility and effectiveness has been demonstrated in HAART(highly active antiretroviral therapy, HAART), AIDS is gradually managed into a chronic disease. But, with the growing popularity of antiviral therapy and the treatment prolonged, drug resistance increase gradually, which lead to first-line antiretroviral treatment failure, and eventual replacement for second-line drugs. In resource-limited areas, health workers mainly rely on virology and immunology to estimate whether antiviral therapy successed to guide to exchange second-line drugs. Meanwhile, In resource-limited areas, some second-line drugs offer poor or people can not sustain exorbitant pricen of second-line drugs, so the option of second-line drugs will be an important and difficult question, sometimes doctors can not fully use second-line drugs according to reference guide. Clinical studies have shown that use lopinavir or ritonavir (LPV/r) alone can lead to different antiviral therapeutic effects, and prone to drug resistance. But the effect of replacing only one drug is now rarely reported. In resource-limited areas, the clinical data of medication guide by immunology and virology in the context of resistance surveillance shortage is insufficiency, and the following project is replacing only one drug, what’s more, integrase inhibitors are not free opened in China. In foreign countries, some studies have proven that RAL have great antiviral feature, But the domestic is still lack of relevant data. This article will discusse the empirical analysis in HIV-infected patients after the initial antiretroviral drug treatment failure in resource-limited area, and analyze the therapeutic value of RAL.The curative effect and safety analysis of the second-line drugsPurpose:This study aims to analysis the virology, immunological treatment effect and security in AIDS patients after replacing second-line drugs in Nanjing.Method:The initial collection program:general conditions(gender, age, weight), HIV infection time, HIV infection route, baseline CD4T+ count, HIV viral load in blood plasma, initial antiviral treatment time, initial antiviral treatment programme and so on. Some biochemical markers before and after taking the second-line drugs, including blood routine, liver function, kidney function, blood lipids, blood glucose, amylase, etc. In this study, Virological failure was mainly against the viral load>400 copies after the virus was completely suppressed, immunological failure meaned CD4T+ cell fell below the baseline, CD4T+cell count persistently lower than 250/mm3.Collection of dressing change status:patient’s general condition when rescue therapy started, including CD4T+ cell count, HIV viral load, concrete proposal of rescue therapy, curative effect of rescue therapy(monitoring CD4T+ cell count, testing viral load, etc), safty of rescue therapy, compliance of the patient, patients with biochemical indicators:blood routine, liver function, kidney function, blood lipids, blood glucose, amylase, etc.Result:Replacing the LPV/r second-line treatment 6 months later, the mean CD4T+ cells increased by 83.37/mm3, the average rosed to 326.28/mm3 after 12 months treatment. The mean value of viral load declined from 71336.6 copies/m to 7371.9 copies/m. Some of the patients simply replaced one drug, CD4T+cells mean value increased by 83.35/mm3 after 6 months treatment, and increased by 273.54/mm3 after 12 months treatment, the mean value of viral load declined from 168015.00 copies/m to 1846.15 copies/m.17 patients experienced gastrointestinal discomfort of 54 cases, including 8 patients with diarrhea, mostly occurred at 22 weeks after initiation of treatment. Most laboratory parameters.were within the normal range, few indicators raised or lowered, in the early medication process, mild to moderate anemia was occurred in 6 patients, of which 4 cases were 3TC+TDF+LPV/r,2 cases were 3TC+AZT+ LPV/r, they were all relieved after conservative treatment. In the early course of taking 3TC+TDF+LPV/r,9 patients occurred mild liver damage, without abnormally increased of bilirubin. As the patients medication time extended, cholesterol and triglyceride gradually rose. In this retrospective analysis of the study, there was no serious liver toxicity and renal toxicity.We collected 1 HIV-infected patients who have taken RAL, because of poor compliance,and irregular medication, antiviral therapy effect is poor.Conclusion:1. Without drug resistance surveillance, and reference virological suppression and immunological treatment to replace LPV/r-based second-line treatment regimen is effective.2.People who was failed antiviral treatment still has a good immunological and virological treatment only after treatment with a different drug in the short term.3.LPV/r as a second-line drugs are still within safe limits, the most common side effects are gastrointestinal reactions. Prolong used can lead to dyslipidemia. |
