初診斷愛滋感染者接受抗病毒藥物治療之免疫力與副作用趨勢變化

林宥捷; 賴怡因; 劉曉穎; 陳嬿今; 劉麗芳; 柯乃熒

doi:10.6224/JN.202002_67(1).08

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P55 - 65

医药卫生 > 预防保健与卫生学
医药卫生 > 社会医学

DOI： 10.6224/JN

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初诊断爱滋感染者接受抗病毒药物治疗之免疫力与副作用趋势变化

Trends in Immunity and Adverse Drug Reactions Among People Newly Diagnosed With HIV

林宥捷(Yu-Chieh LIN) ；赖怡因(Yi-Yin LAI) ；刘晓颖(Hsiao-Ying LIU) ；陈嬿今(Yen-Chin CHEN) ；刘丽芳(Li-Fang LIU) ；柯乃荧(Nai-Ying KO)

护理杂志； 67 卷 1 期 (2020 / 02 / 01) ， P55 - 65

繁体中文 DOI： 10.6224/JN.202002_67(1).08

爱滋病； CD4数值；症状数；症状强度；药物副作用； HIV ； CD4 count ； number of symptoms ； intensity of symptoms ； adverse drug reactions

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摘要 │ 参考文献 (31) │ 国际计量

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Background: Early antiretroviral therapy (ART) is recommended as an intervention for HIV by the World Health Organization. However, the association between the CD4 count at ART initiation and the risk of adverse drug reactions (ADRs) remains unclear. Purpose: This study aimed to describe the trends related to symptom number and intensity among patients newly diagnosed with HIV in three different CD4-count-based groups and then to investigate the ADR trends for these three groups at different points in time. Methods: This multi-center cohort study recruited newly diagnosed HIV/AIDS patients who had not previously used ART from AIDS-designated hospitals in Taiwan from March 2015 to December 2016. Study measures were assessed at the time of case enrollment (T0) and during the 1st month (T1), 4-6th month (T2), and 7-9th month (T3) of ART treatment. Patients were stratified into three groups according to initial CD4 count: ≤ 350 cells/mm^3, ＞ 350-500 cells/ mm^3 and ＞500 cells/mm^3. Repeated measures ANOVA and generalized estimating equations were used to estimate the relationships between the level of initial CD4 count and ADRs. Results: A total of 207 patients completed the study. Mean symptom numbers and symptom intensities decreased significantly over time in all three groups (p ＜ .01). The largest mean reduction in both symptom number and intensity was achieved by the CD4 count ＞ 500 cells/mm^3 group. Overall, at least one ADR was reported by 85.7% of the participants at the first month of ART use, and the incidence of ADR had decreased by an average of 22% at the 7-9th month assessment (p ＜ .001). ARDs decreased significantly over time in the CD4 count ＞ 500 cells/mm^3 group, with the degrees of ADRs in systematic side effect most significantly decreased in this group (p = .03). Conclusions/ Implications for Practice: Number and intensity of symptoms significantly improved over time in all three CD4 count groups. The percentage of systematic side effects was most reduced in the CD4 count ＞500 cells/mm^3 group. The results of this study may be referenced by HIV care providers when discussing with patients the initiation of ART and the potential risks of experiencing ADRs.

参考文献 ( 31 ) 〈TOP〉

Ammassari, A.,Murri, R.,Pezzotti, P.,Trotta, M. P.,Ravasio, L.,De Longis, P.,Antinori, A.(2001).Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection.Journal of Acquired Immune Deficiency Syndromes,28(5),445-449.
Apostolova, N.,Funes, H. A.,Blas-Garcia, A.,Galindo, M. J.,Alvarez, A.,Esplugues, J. V.(2015).Efavirenz and the CNS: What we already know and questions that need to be answered.Journal of Antimicrobial Chemotherapy,70(10),2693-2708.
Bezabhe, W. M.,Bereznicki, L. R.,Chalmers, L.,Gee, P.,Kassie, D. M.,Bimirew, M. A.,Peterson, G. M.(2015).Adverse drug reactions and clinical outcomes in patients initiated on antiretroviral therapy: A prospective cohort study from Ethiopia.Drug Safety,38(7),629-639.
Cooper, R. D.,Wiebe, N.,Smith, N.,Keiser, P.,Naicker, S.,Tonelli, M.(2010).Systematic review and meta-analysis: Renal safety of tenofovir disoproxil fumarate in HIV-infected patients.Clinical Infectious Diseases,51(5),496-505.
DiBonaventura, M. D.,Gupta, S.,Cho, M.,Mrus, J.(2012).The association of HIV/AIDS treatment side effects with health status, work productivity, and resource use.AIDS Care,24(6),744-755.

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