据中国医药报讯 北京协和医院李太生教授等以协和医院为全国研究中心，联合国内十家医疗机构，建成中国艾滋病临床研究平台，并持续开展国家传染病重大专项“成人艾滋病抗病毒和免疫重建研究”。课题组围绕优选新方案、降低病死率、免疫功能无应答的发生机制等展开研究，在最优性价比一线治疗方案、降低发病率、病死率和治疗费等方面取得了重要突破性成就。
——优选出艾滋病治疗一线方案
既往20余年国际国内研究证实，“鸡尾酒”疗法是“降低艾滋病发病率和病死率”的最有效手段。然而，相对于西方发达国家有30多种药物来说，我国国产仿制抗病毒药物种类非常有限，因此建立有效、毒副作用小的最优药物组合方案，是我国控制艾滋病疫情、降低发病率和死亡率的重要手段。
课题组建立了510例初治患者的一线药物治疗队列、100例治疗失败后应用二线药物的治疗队列，以及60例一线药物长期持续性治疗队列等三个不同的治疗队列并开展研究。肯定了国产仿制药的疗效，并在国际上率先提出以国产仿制药为主的优化治疗方案，即司他夫定（D4T）+拉米夫定（3TC）+奈韦拉平（NVP）治疗6月后更换为叠氮胸苷（AZT）+3TC+NVP长期持续。新方案最大程度地避免了AZT的短期骨髓抑制和D4T的长期脂肪营养不良等毒副作用，患者的依从性和耐受性显著提高。仅以2011年新发患者为基数，采用新优选方案后可节约药费9100万元。
李太生表示，这一迄今性价比最高的方案，有望在资源匮乏的国家和地区推广应用，成为抗病毒治疗的首选方案。
——总结出一套提高艾滋病治疗成功率的经验
研究结果表明：经对657例患者给予上述的优化一线方案治疗一年后，其艾滋病病毒完全抑制率显著提高到70%以上，达国际水平。与此同时，年病死率显著降低至1.1%（7/657），而中国CDC 2008年公布的这一数值为4.6%。
李太生介绍了该研究课题总结的关于提高治疗成功率、降低病死率的经验，包括：强化医务人员培训，规范艾滋病治疗；加强健康教育和科普宣传，提高患者的治疗依从性；规律检测患者体内病毒数量并及时反馈给其主管医生；根据患者情况选择合理的治疗方案，如对CD4计数大于250、或者合并丙肝的患者避免使用NVP，合并HBV的患者应使用含TDF的方案等；密切监测并及时处理药物毒副反应；提高各中心临床医务人员参与临床科研的意识。
——发现了新的艾滋病病毒储藏库
在长期接受鸡尾酒治疗的艾滋病患者血液中病毒载量检测不到的情况下，课题组在泪液中检测到较高水平的病毒载量，提示泪腺和/或泪液相关的组织、器官极可能为艾滋病病毒的“新窟”，这为将来完全根治艾滋病提供了新思路。
——发现艾滋病患者治疗后免疫功能重建不全的原因
随着艾滋病抗病毒治疗的深入和治疗时间的延长，约5%~30%的患者免疫系统未能恢复，发生机会性感染的可能性仍然较高，病死率会增加。课题研究表明，部分患者经长期有效治疗后免疫功能无法恢复的主要原因在于胸腺功能的衰竭。如果患者治疗开始前免疫功能破坏更为严重，胸腺新生免疫细胞数量很低，治疗开始后异常的免疫激活降低不明显等情况出现，就可提前判定这类患者治疗后可能会出现免疫功能无法恢复的情况。以上研究结果对开展临床治疗、明确中药研发方向具有重要指导意义。 |
艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复
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| 图示∶2011年5月正式出版的《中国特色医疗金鉴》登载的刘君主任及其机构事迹 |
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艾滋病新鸡尾酒疗法 附 HIV感染者，早吃药早受益
China's AIDS antiviral therapy has achieved encouraging results
December 7, 2011
According to Chinese Medicine News reports such as Beijing Union Medical College Hospital Professor Li Taisheng to Concord Hospital for the National Research Center, the United Nations ten medical institutions, built China's AIDS clinical research platform, and continue to carry out major projects of national disease "adult AIDS anti-viral and immune reconstitution of . " Around the group preferred the new program, reduce mortality, the incidence of immune response mechanisms without a study, the optimal cost-effective first-line therapy, reduce morbidity, mortality and treatment fees, made an important breakthrough achievements.
- Preferred first-line treatment of AIDS
Past 20 years of domestic and international research confirms that the "cocktail" therapy is to "reduce AIDS morbidity and mortality," the most effective means. However, compared to Western developed countries have 30 kinds of drugs, the China-made generic antivirals is very limited, so the establishment of effective and toxic side effects of optimal drug combinations program, controlling the AIDS epidemic in China, reduce morbidity and mortality rate an important means.
Task Force set up 510 previously untreated patients with first-line drug treatment queues, 100 cases of treatment failure after the application of second-line drug treatment queues, and 60 cases of first-line treatment of drug long-term sustainability of three different treatment queue queue and to conduct research. Confirmed the efficacy of generic drugs domestically and internationally-made generic drugs first made to the optimization-based treatment programs that stavudine (D4T) + lamivudine (3TC) + nevirapine (NVP) treatment for 6 months replaced by zidovudine (AZT) +3 TC + NVP long-term sustainability. New program to maximize short-term AZT to avoid bone marrow suppression and D4T long-term lipodystrophy and other side effects, patient compliance and tolerability improved significantly. Only new-onset patients in 2011 as the base, the introduction of new drugs preferred program after saving 91 million yuan.
Litai Sheng said that the most cost-effective solution so far is expected in resource-poor countries and regions, promote the application of anti-viral treatment as the preferred solution.
- Summed up a set to improve the experience of HIV treatment success rate
The results show that: of 657 cases were treated by the optimized first-line treatment after one year, the complete inhibition of HIV was significantly increased to 70% or more, up to international standards. At the same time, the annual mortality was significantly reduced to 1.1% (7 / 657), and China CDC 2008 of the published value of 4.6%.
Li Taisheng presented the summary of research on improving treatment success rates and reduce mortality experience, including: strengthening the training of medical personnel, standard AIDS treatment; to enhance health education and scientific propaganda, and improve patient compliance; regular testing in patients with viral the number of its competent and timely feedback to physicians; according to the patients to choose a reasonable treatment options, such as CD4 counts greater than 250, or combined hepatitis C patients to avoid using NVP, should be used in patients with HBV combined with TDF's programs; close monitoring and timely handling of drug toxicity; enhance the clinical medical staff involved in clinical research and awareness.
- The discovery of new HIV repository
In the long-term treatment of AIDS patients receiving a cocktail of blood viral load undetectable in the case, the research group detected in the tear higher levels of viral load, suggesting that the lacrimal gland and / or tear-related tissues, organs most likely to AIDS virus "new cave", which completely cure AIDS for the future provides a new idea.
- Found in AIDS patients after immune reconstitution causes incomplete
With the deepening of AIDS antiretroviral treatment and treatment time, about 5% to 30% of patients failed to restore the immune system, the possibility of opportunistic infections is still high, mortality will increase. Research shows that effective treatment in some patients after long-term immune function can not be restored after the main reason for the failure of thymus function. If the patients before the start of more serious damage to the immune function of the thymus is very low number of new immune cells, after the start of treatment to reduce abnormal immune activation is not obvious and so there, you can determine in advance the treatment of these patients may occur after the immune function can not be restored the situation. To carry out the above findings for clinical treatment, a clear direction of traditional Chinese medicine research and development of important guiding significance.
Source: China Pharmaceutical News
Author: Duan Wen-Li
Zebian: river
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