摘要目的:了解艾滋病患者抗病毒疗效的影响因素。方法:选择2016年1月至2018年6月在北海市人民医院艾滋病门诊初治且依从性良好的107例艾滋病患者，根据患者是否自愿接受中药治疗分为两组，接受高效抗反转录病毒治疗(highly active anti-retroviral therapy，HAART)联合平肝解毒方剂治疗组(42例)，单纯接受HAART组(65例)。比较两组患者在治疗48周时的病毒学和免疫学应答情况。采用聚合酶链反应产物直接测序法对白细胞介素-28B(interleukin-28B，IL-28B) rs12979860进行基因分型。采用logistic回归分析艾滋病患者抗病毒疗效的影响因素。组间比较采用独立样本 t检验、配对样本 t检验或 χ2检验。 结果:治疗48周时，42例HAART联合平肝解毒方剂组患者中，41例(97.62%)获得了病毒学应答，65例单纯HAART组患者中有58例(89.23%)获得了病毒学应答，差异无统计学意义( χ2＝0.100， P>0.05)；HAART联合平肝解毒方剂组患者的CD4 +T淋巴细胞计数增加了(244.32±101.83)/μL，与单纯HAART组患者的(211.56±112.50)/μL相比，差异无统计学意义( t＝1.522， P>0.05)。92例携带IL-28B CC基因型的患者中，88例(95.65%)获得了病毒学应答，而15例携带IL-28B非CC基因型患者中有11例获得了病毒学应答，差异无统计学意义( χ2＝0.394， P>0.05)。携带IL-28B CC基因型患者的CD4 +T淋巴细胞计数增加了(229.72±101.17)/μL，高于携带IL-28B非CC基因型患者的(173.40±89.64)/μL，差异有统计学意义( t＝2.028， P＝0.045)。多因素logistic回归分析显示：基线CD4 +T淋巴细胞计数≤200/μL、IL-28B CC基因型、HAART方案中含蛋白酶抑制剂有助于提高抗病毒的疗效。 结论:基线CD4 +T淋巴细胞计数≤200/μL、IL-28B CC基因型、HAART方案中含蛋白酶抑制剂是艾滋病患者抗病毒疗效的影响因素。

abstractsObjective:To explore the factors affecting the antiviral treatment efficacy of acquired immunodeficiency syndrome (AIDS) patients.Methods:A total of 107 patients diagnosed with human immunodeficiency virus (HIV) infection in the clinic of Beihai People′s Hospital from January 2016 to June 2018 were selected.The patients were divided into two groups according to whether they voluntarily accepted traditional Chinese medicine treatment, including treatment group who received highly active anti-retroviral therapy (HAART) and traditional Chinese medicine prescription of Ping Gan Jie Du (42 cases), and control group who were only treated with HAART (65 cases). The virological and immunological responses were compared between the two groups at 48 weeks of treatment. The interleukin-28B (IL-28B) rs12979860 genotypes were measured by using the direct sequencing of polymerase chain reaction products. Logistic regression was used to analyze the influencing factors of antiviral efficacy in AIDS patients.Comparison between groups was performed by independent sample t test、matched sample t test or chi-square test. Results:At week 48 of treatment, 41 (97.62%) of the 42 patients in the HAART plus Ping Gan Jie Du group obtained virological response, while 58 (89.23%) of the 65 patients in the HAART group alone acquired virological response, which was not significantly different ( χ2=0.100, P>0.05). The numbers of CD4 + T lymphocytes increased at week 48 of treatment in the HAART plus Ping Gan Jie Du group and HAART group were (244.32±101.83)/μL and (211.56±112.50)/μL, respectively. The was no statistically significant difference ( t=1.522, P>0.05). Among the 92 patients with IL-28B CC genotype, 88 (95.65%) acquired virological response, while 11 of the 15 patients with non-IL-28B CC genotype acquired virological response, which was not significantly different ( χ2=0.394, P>0.05). And CD4 + T lymphocytes in patients with IL-28B CC genotype increased ((229.72±101.17)/μL), which was higher than that without IL-28B CC genotype ((173.40±89.64)/μL), with statistically significant difference ( t=2.028, P=0.045). Multivariate logistic regression analysis showed that baseline CD4 + T lymphocyte count≤200/μL, IL-28B CC genotype, and treatment plan including protease inhibitor were helpful to improve the antiviral efficacy. Conclusion:Baseline CD4 + T lymphocyte count ≤200/μL, IL-28B CC genotype, and protease inhibitor in HAART regimen are the influencing factors of antiviral efficacy in AIDS patients.