Evaluation For Six-year's Highly Active Antiretroviral Therapy In Chinese HIV-1 Infected Patients

For more than 20 years,AIDS to people's health and life of the harm caused by the more and more serious,has become government attaches great importance to the major public health problem.Highly effective antiretroviral treatment(HAART) the application and promotion,making antiretroviral therapy achieved good clinical results,effectively reduces HIV-associated morbidity and mortality,improve the survival of the infected persons quality,are AIDS treatment and prevention history of an important milestone.In recent years,China has about HAART efficacy of many articles and reports,but only short-time of observations,More than four years of long-term antiviral efficacy has not yet reported.However,HIV infection is chronic and that exposure to HAART is likely to be life-long,there is a need to evaluate the long-term effect of HAART in this population.In this paper,we first report the long-term follow-up of 57 antiretroviral(ARV) drug-naive Chinese patients for 6 years.This study includes two parts as follows: PartⅠEvaluation for Six-year's Highly Active Antiretroviral Therapy In Chinese HIV-1 Infected PatientsObjective:To evaluate the long-term efficacy and tolerability of nevirapine(NVP)-based regimens in the treatment of HIV-infected Chinese patients in routing clinical practice.Design:Six-year follow-up of a study of NVP-based HAART.Methods:HIV-infected,atiretroviral -naive patients originally received two nucleoside reverse transcriptase inhibitors(NRTIs) and nevirapine had HIV RNA levels,T lymphocyte subsets and safety assessed over 6 years.Results:Of 57 patients,34 patients participated in long-term follow-up.After 5-6 years,more than 60%of subjects had HIV RNA levels＜50 copies/ul,and the median increase in CD4 cell count from baseline was 329 cells/μl.Gamma-GT increased occurred in seventeen patients(29.8%),Serum cholesterol and triglyceride elevations occurred in fifteen patients(26.3%),six(10.5%) patients developed lipodystrophy, mainly in female patients.Grade 3/4 adverse events occurred in three cases(at month 5,6,8).One subject experienced grade 3 rashes(at month 4).Conclusions:Antiretroviral therapy with NVP-based regimens suppressed HIV viremia and produced continued CD4 cell increases in a majority of subjects for 6 years.Safety and tolerance were good with no unexpected long-term toxicity.This study demonstrates the durable effects of antiretroviral therapy of Chinese patients.PartⅡResistance mutations in HIV-infected Chinese patients On NVP-based HAARTObjective:To assess the long-term resistance mutations of nevirapine(NVP)-based regimens in HIV-infected Chinese patients in routing clinical practice.Methods:From October 2002 through May 2004,57 HIV-infected patients commenced antiretroviral therapy(ART).Genotypic resistance tests on plasma RNA(VL＞1000 copies/ml) were carried out before treatment(n=57).Additionally,patients developing VR(virological rebound) were also tested at rebound(n=5).57 HIV-infected patients are naive for antiretroviral drugs.Results:Analyze the 57 purpose gene fragment,pre-HAART(n=52), post-HAART(n=5).None had PI Major Resistance Mutations.PI Minor Resistance Mutations were generally existed,including major types of M36I,I93L,H69K and L63P,Seven(13.5%) of the 52 patients showed NRTI -associated mutation[L210S,M41I,T215H,A62V,T69S,(T215Y,K219R) and K70R].one patient showed NNRTI-resistance mutations(V179D).Secondary resistance outcome:the resistance mutation on PI Major Resistance Mutations and PI Minor Resistance Mutations,there are some patients that had many mutations on both of NRTIs and NNRTIs simultaneously.Conclusion:There were primary and secondary drug resistance in naive HIV-1 infected patients in human province,but the prevalence was low,termly and systematic detection for gene resistance will be necessary before and during treatment by HAART to guide anti-HIV therapy. NVP-based HAART allows maintenance of successful long-term control of HIV replication.VR on NVP-based HAART is characterized by the emergence of NNRTI cross-resistance mutation.