【摘要】：目的系統(tǒng)評價早期抗逆轉(zhuǎn)錄病毒治療(antiretroviral therapy,ART)對無癥狀HIV感染者的有效性和安全性,探討無癥狀HIV感染者ART的最佳啟動時機(jī)。方法計算機(jī)檢索Pub Med、EMbase、The Cochrane Library(2016年4期)、CBM、CNKI、VIP及Wan Fang Data數(shù)據(jù)庫,全面搜集有關(guān)無癥狀HIV感染者ART最佳啟動時機(jī)或早期治療的隨機(jī)對照試驗(RCT)。檢索時限均從1996年1月至2016年4月。由2位研究員按納入與排除標(biāo)準(zhǔn)獨(dú)立篩選文獻(xiàn)、提取資料并評價偏倚風(fēng)險后,采用Rev Man 5.3軟件進(jìn)行Meta分析。結(jié)果共納入4個RCT,8 751例患者。Meta分析結(jié)果顯示,在CD 4+T淋巴細(xì)胞計數(shù)(CD 4計數(shù))≥350個/μL時,包括CD 4計數(shù)≥500個/μL時啟動ART,相對于延遲至CD 4計數(shù)350個/μL時啟動ART治療,更能給HIV感染者帶來明顯獲益:1在CD 4計數(shù)≥350個/μL時啟動ART,患者AIDS病情進(jìn)展的風(fēng)險顯著下降[RR=0.49,95%CI(0.38,0.64),P0.001];若在CD 4計數(shù)≥500個/μL時就啟動治療,AIDS病情進(jìn)展風(fēng)險還可進(jìn)一步下降[RR=0.38,95%CI(0.24,0.59),P0.001];2在CD 4計數(shù)≥350個/μL時啟動ART,患者發(fā)生嚴(yán)重非AIDS相關(guān)事件的風(fēng)險顯著下降[RR=0.58,95%CI(0.40,0.83),P=0.003];3在CD 4計數(shù)≥350或500個/μL時啟動ART,相較于延遲啟動治療的患者,兩組全因死亡率[RR=0.70,95%CI(0.48,1.02),P=0.06]以及隨訪期間發(fā)生嚴(yán)重不良反應(yīng)事件的風(fēng)險[RR=0.67,95%CI(0.38,1.20),P=0.18]的差異并無統(tǒng)計學(xué)意義。結(jié)論本研究結(jié)果支持對所有CD 4計數(shù)在350~500個/μL的無癥狀HIV感染者啟動ART。針對CD 4計數(shù)在500個/μL以上的患者,亦建議啟動治療。隨著治療覆蓋面的擴(kuò)大和治療時間的延長,應(yīng)進(jìn)一步加強(qiáng)患者的服藥依從性教育和隨訪管理,控制耐藥毒株在人群中的流行,預(yù)防長期治療帶來的遠(yuǎn)期不良反應(yīng)。
[Abstract]:Objective to evaluate the efficacy and safety of early antiretroviral therapy (antiretroviral therapy,ART) in asymptomatic HIV infected patients, and to explore the best start-up time for asymptomatic HIV infected patients with ART. Methods Pub Med,EMbase,The Cochrane Library (2016 issue 4), CBM,CNKI,VIP and Wan Fang Data databases were searched by computer to collect the best start time or early treatment of ART in asymptomatic HIV infected patients. (RCT). Was used as a randomized controlled trial. The time limit for retrieval is from January 1996 to April 2016. According to the inclusion and exclusion criteria, two researchers independently sifted the literature, extracted the data and evaluated the bias risk, and then analyzed the data with Rev Man 5.3 software. Results four patients with RCT,8 were included. Meta analysis showed that when CD 4 T lymphocyte count (CD 4 count) 鈮，

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