CHUYEN pg; Hdi NGHj KHKT CAC TJNH VClSB DUVeN HAI BAC B<I U W THO WHAT
DANH GIA Hiiu QUA SUT DUNG THUOC K H A N G R E T R D V I R U S TREN DENH N H A N HIV/AIDS TAI D | N H VIEN HOU NGHj VIET n f P HAI PHONG
Hodng Thi Kim Huyen*
SSng Tb^nh Dong**, Nguyin Thj Hiln"
TOIW TAT
Oe c6 each nhin sd bp vii benh nhan HIV/AIDS va hieu qua dieu tri thuoc khang retrovirus (ARV) ciio niiffng benii nhan niiy, cliung toi tien iianii nglii^n cihj tien cuti m6 ta Ithong can thiep tren b?nh nhan dlSu trj HIV/AIDS lan dau tien trong chuOng trinh Pepfar tai phong Itham ngoai tru benh vISn Hi?u ngtii Viet Tiep Hal Phong. Tat ca BN d do tuoi lao dong til 20-60 tuoi, nam gidi gap 3 lan nil' gidi, so BN 4 glai doan benh tien triSn chiem ti le cao (72,5%) va mSc kem nhieu benh irrCH. Vdi kha nang tuan thu 92,5 - 96,25% mang iai hieu qua dieu tri ro ret the hi^n ca tren tien trien lam sang (47,5 - 60% BN tang can, 1,25 - 5% CO NTCH mac m6i) va dap uTig mien djch (chi so CD4 tSng 131,18 dOn vj sau 6 thang). Cac ADR gSp nhieu trang thang dau dieu trj va giam dan d cac thang tiep theo nhutig mii'c do nghiem trpng tSng len, anh hu'dng den to chu'c da, he tieu hoa, gan, he TKTW, TK ngoai bien, he tao mau, cd, roi loan lipid. Nhu- vay, dieu tri ARV la rat can thiet cho benh nhan HIV/AIDS.
SUMIMARY
In order to have a general view of HIV/
AIDS patients and the effect of Antiretroviral (ARV) when used to treat these patients, we have carried out a prospective study on description of non-interference on the patients treated with ARV for the first time in Pepfar program at the outpatient surgery of Friendship
• Dqi hoc Dufrc Ha Ngi: •• Benh vifn Vifl Tifp
Viet Tiep Hospital. The results are: All of the patients are at the labor age from 20 to 60 yeare old; the rate of male patients are three times as many as that of female patients; those having the disease In progress account for high rate (72,5%) as well as having other opportunist infections. That the patients have followed Bie treating method has brought about obvious effects on clinical progression (47,5 -60% of tlie patients have gained weight; 1,25 -5% inddence of opportunist infections) and immune response (CD4 has risen 131,18 unit after 6 montlis treated). There were quite many patients getting ADR in the first months but tlie rate decreased after that (month by month). However, tlie serious effects increased, having influence on skin cells, digestion, liver, the central neuros, peripheral neuropathy, muscles, hematopoietc system, lipid disorder. Therefore, treating HIV/AIDS patients with ARV is very necessary and important.
I. O^T V&N o f
HIV/AIDS 14 mpt d?i dicli nguy liiem doi vol Slic Uioe, tinh mang con ngucri va tiromg lai noi giong cua dan tpc, tic dpng true tiSp ain s\i ph4t triSn bin vihig cila ddt nuoc.
Bin nay dich HIV/AIDS da xuit hien d tit cl cac tinh thanh, cac vung mifin trong ci. nudc.
Dilu tri thudc Ichang Retrovirus (ARV) 14 mpt phin trpng t6ng thj c4c dich vy cham soc va hp trg ve y te chp ngudi nhilm HIV/AIDS. Vol mpng mu6n gdp phin nang
Y H p c VlfeT NAM T H A N G 5 • s 6 o A C BlgT/2Q13
cao hi6u qua diSu tri, dac biet dieu tri ARV la diSu tri su6t din, chiing toi tiln h ^ h dl tai
"Ddnh gid hi$u qua su d^ng thudc khdng Retrovirus tren b?nh nhdn HIV/AIDS tai Binh viin hihi nghf Vi$t Ti^p Hai Phdng " nham:
1. Phdn tich tinh hinh chung ciia benh nhdn HIV/AIDS
2. Bdnh gid hi^u qud sic dung thuoc AR V trin mdu nghien cim.
II. o6l TUpNG VA PHIKJNG PHAP NGH|£N CCOJ - D^i tir^nng nghien CITU la nhihig b^nh nhan HIV/AIDS ngucri lon dugc kham va di§u tri ARV lan dau tien trong chucmg trinh
Pepfar tai ph6ng kham ngoai tni benh vien h&u nghj Vi?t Ti?p HP.
- Thiet kl nghien cihi: Nghi&n cuu tiln Cliu mo ta khong can thi?p. Benh nhan (BN) dugc lua chgn bit dau tir 6/2011 den 12/2011. Th6i gian nghien cim d6i vai timg BN k^o dai trong 6 thdng. Th5m kham lam s^g, can lam s^ng dugc th\rc hi?n tnrdc khi dieu tri v^ trong cac Ian tii khdm.
Tieu chuSn ddnh gia: theo «Hudng dan chan doan va dieu trj nhilm HIV/AIDS»
cuaB9Yte[l;3].
Phvong phdp xvt ly so lieu: theo phuang phap thong ke y hpc, sii dung phin mim SPSS 17.
III. KET QUA VA BAN LUAN
1. Tmh hinh chung cua benh nhan HIV/AIDS
Co 80 benh nhan tham gia du 6 thang dieu tri ARV. Kit qua dat dugc nhu sau:
Ll. Bac diim vi tudi vd gi&i
Bang 1 - Phan do tuoi va giai tinh trong mau nghien cuu Tuoi
<20 20-39 40-59
>eo
Tong sS
Nam SoBN
0 40 13 0 53
Ti le Vo 0 50.00 16.25 0 66.25
Nir SoBN
0 20 7 0 27
Ti le »/o 0 25.00
8.75 0 33.75
Tong so SoBN
0 60 20 0 80
Ti le o/o 0.00 75.00 25.00 Q.QO 100
Toan bp 80 b^nh nhan tir 20 din 60 tu6i.
Trong do, ti le nam 66,25%, nii' 33,75%. Dp tuoi thanh niSn chilm 75%, d6 tuoi trung nien chiem 25%. Kit qua nay tuong duong so vai tinh hinh chung cua ca nuoc cuoi nam 2011 [2] (nam 69% va nii 31%, tu6i tir 20 - 39 chilm 82%). loan bg BN dang trong do tuoi lao dpng chinh cua moi gia dinh va xa
hpi, vi vay hg se g|.p nhieu kho khan trong cong vi?c va on djnh cupc song. Han niSa, nhOmg nguai a dp tuoi nay co nguy co truyen benh cao trong cgng dong nen ben canh viec giiip dd va huang dan sir dung thuoc phii hgp can tu van de nguai benh kiem soat va khong chl sy: lay benh bang li^u phap thay doi hanh
CHUYEN Eg: HOI NGHI KHKT CAC TJNH VUNG DUYtN HJI BAC BQ U N THOTNH<iT 1.2, Btr&ng Idy truyen
Bdng 2 - Dac dilm v l duang lay truyen
Du'dng ldy truyign
Mau Tinh due Khong ro T6ng so
Nam sa'BN
29 21 3 53
Ti 1$ % 36.25 26.25 3.75 66.25
na
SoBN 3 22 2 27
Ti 1$ % 3.75 27.5 2.50 33.75
Tdng so SoBN
32 43 5 8 0
Ti IS % 40.0 53.75 6.25 100 Nh^n xit: Ci nam gidi, lay nhiem qua dudng mau 36,25%, dudng tinh d\ic 26,25%.
Ngupc lai, d nil gidi lay nhiem qua dudng tinh due 27,5%, dudng mau chi cd 3,75%.
Ti le lay qua dudng tinh diic la 40,0%, qua dudng mau la 53,75%. Nhu vay, ti le lay nhiem qua dudng tinh due cua mau nghien cdu cao hem so vdi trung binh ciia ca nudc nhimg daycung la xu hudng ehung ciia tinh trang lay nhiem HIV/AIDS hi?n nay: giam ti le lay nhilm qua dudng mau va tang ti le lay nhiem qua dudng tinh due.
1.3.Giai doan lam sdng vd cdc benh mdc kem
Hinh / - Ti le giai doan lam sang
33 75 ^ _ 38 75
.IIL
• ^ l ^ ^ HCV Lao N5m Nim P ^ N&m Nim P m Zona, harper Bacn s.Hittk 2-Tili cfc benh mSc Kem
Y H p c VI$T NAM THANG 5 - SO PAC BlgT/2D13
So BN 6 giai d o ^ benh tien trien va nang chiem ti I? kha cao (lam sang 3; 4 deu co 36,25%). 6 giai doan nay, mgt BN co thi nhiem d6ng thai nhilu benh NTCH. Cac benh chilm ti 1? cao la viem gan B 10%, viem gan C 38,75%, lao 42,5%, ndm 38,75%. Trong khi d6, hau hSt cac thuoc ARV va c^c thuoc dieu tri NTCH deu dugc chuyen hoa qua gan va phai sii dyng suot d6i. Do vay, nguy co gay nhiem dpc gan cang tang cao khi dieu tri cho nhihig benh nhan nay [7].
2. Danh gid hieu qua sir dung thuoc ARV tren mau nghien cihi.
Tudn tha diiu trj.
Bdng i - Ti le tuan thii dieu trj theo thai gian
Mu'c do t u a n t h u
%
> 95 9 0 - 9 5 8 0 - 8 9 7 0 - 7 9 ' 70
Ti le thanh cong
°/o 81 64 50 25 6
3 thdng tfau S o B N
74 4 I 1
Ti le % 92.5
5 1.25 1.25 0
3 t h a n g tiep theo ScfBN
77 2 1
Ti le % 96.25
2.5 1.25 0 0
Nhdn xet: Trong 3 thang dau dieu tri, tuan thu > 95% chiem 92,5%. Trong 3 thang tiep theo, s6 benh nhan tuSn thu > 95% da tang len 96,25%.
Ti le tuan thu nay cung tucmg duang voi mgt nghien ciiu cua Pham Thi Hanh Phuc ve thuc hanh ART cua BN HIV/AIDS tai phong kham ngoai tru BV Viet Tiep la 92,3 - 92,7 % [4]. Theo thai gian, kha nang tuan thu dieu tri cua benh nhan tang dan do da hinh thanh thoi quen su dung thuoc va cac ADR cung giam dan. Vai muc dp tuan thii tren cung dong nghia vai ti le thanh cong trong dilu tri dat dugc > 81% [5].
Hiiu qud diiu triARVthi /tiin trin tien trien ldm sdng vd ddp ung miin dich Bdng 4- Cac bieu hien lam sang
Bieu hien
Tang can NTCH mdi mac
NTCH tai phat
Sau 3 thang S o B N
38 4 1
T i le % 47.5
5 1.25
Sau 6 thang S o B N
48 1
Ti le o/o 60 1.25
CHUYtN DJ: H^l NGH| KHKT CAC TINH VUNQ OUYtN HAI B A C B ^ UM T H O N H < T ^ ^ Sau 3 thing dieu trj cd 47,5% b?nh nhfin tSng cfin; 5% mdi mSc NTCH ; 1,25% NTCH tai phdt. Sau 6 thdng iiiu trj cd 60% tdng cdn, 1,25% mdc mdi NTCH.
Bdng 5 - Ddp umg miln djch ciia mau Thdng x6t nghidm
Bdt dau dieu trj Sau dieu trj
Chi s8 CD4 trung binh
120.86 ± 31,20 252.04 ± 45.67
P
P„-6 < 0,001
Sau 6 thdng diSu trj chi so CD4 trung binh dd tdng them 131,18 don vi, sv khac hist n cdy nghta thong ice vdi p<0,001.
Bang 6 - Ti le tdng CD4 trong di6u trj ARV CD4
(TB/mm3)
<50 51 - 200 201 - 350 351 - 500
>500
Bit tfSu diSu tri soBN
33 27 16 3 1
Ti le »/o 41.25 33.75 20.00 3.75 1.25
Sau diSu trj S S B N
2 37 26 6 9
Ti 1$ % 2.50 46.25 32.50 7.50 11.25
P P< 0,001
P< 0,05 P< 0,01 P< 0,001 P< 0,001 Cd su ddp tag ro ret trong viec thay ddi chi so CD4 trudc vd sau dieu trj: CM < 50 trudc dieu tr; cd 41,25%, sau 6 thdng cdn 2,50 %.
CIM > 500 (suy giam mien dich Ididng ddng kl) trudc di Ju tri 1,25%, sau 6 thang tdng 11,25%.
Til cdc ket qua tren cho thay vi?e dieu trj bdng thuoc ARV dd mang lai hi?u qud rS ret tren dap tag mien djch vd ti«n triSn lam sang chp ngudi b?nh. Viec Ivra chpn phac dd dik trj la phil hpp vdi ttag b?nh nhan. Vd iiiu trj ARV la rdt cdn thiSt cho nhtag bSnh niian
HIV/AIDS. •
ADR tdi cdc cd quan
Da
Sau 1 thing S6BN
11 o/o 13.75
Sau 3 thing S6fBN
2 o/o 2.50
Sau 6 thing
SoBN
%
Y Hpc Vigr NAM THANG 5 - S6 BjiC Bi$raoi3
Tifiu hoa Gan Thdn
Thdn kinh trung Udng Than kinh ngoai bien He tao mau Cd Roi ban lipid TongsS
8 i
1 12
1 1 2
40 10.00
5.00 1.25 15.00
1.25 1.25 2.50
50 2 9 1 4 4 4
1 27
2.50 11.25
1.25 5.00 5.00 5.00
1.25 33.75
8
2 3 1
1 15
10.00
2.50 3.75 1.25
1.25 18.75 Nhan xet: Ti 1$ cac tac dyng khong mong muon tang cao 6 thdng dau dieu tri vai 50 %.
Cac thang tilp theo, tl le nay g i ^ d ^ . Sau 3 thang, con 33,75%, sau 6 thang, con 18,75%.
Bdng « - Ti 1? cac ADR cSn xijr tri xit tri Tlf khoi Ddng thuoc ho trp
Thay phac do
Tan xuat 10 54 14
Tile 12.82 69.23 17.95
Nhdn xit: Cd 12,82% cdc ADR Hi khdi, 69,23% phai dimg them cdc thudc hd trp nhu:
giam dau, khdng histamine, thudc trj tieu ehay,... Ngoai ra, cd 17,95% cdc ADR d muc nghiem trpng phdi thay ddi phdc dd dieu trj.
Trong thang dau dieu tri, ti ie g$p ADR riit cao nhimg d muc dp nhe vd cd the t\r Ididi sau mpt thdi gian dilu trj hoac dilu chinh che 1I9 sinh hoat, gid u6ng thuoc. Trong nhtag thang tilp theo, ti 1$ xudt hi$n cdc ADR giam hin (sau 3 thdng 33,75%, sau 6 thdng 18,75%) nhimg d mure dp n ^ g hon, phdi sir dimg cdc thuoc ho trp ho|c phdi thay ddi phac dl dilu trj [8]. Nhu vay, cdng tdc tu vdn cho BN tu phdt hi$n ADR vd giam sdt ho trp .liieu trj cua nhdn viSn y tl & gia dinh cdn
dupc phdi hpp chat chl de kjp thdi xur ly cdc ADR gdp phdi. Nhd dd, gpp phan nang cap chdt lupng vd hieu qud dilu trj eho ngudi benh.
tv. KiT LUifiN
1. Tinh hinh chung ciia bfnh nhan HIV/AIDS
Todn bp benh nhan d dp tudi tu 20 den 60 tupi. Nam gidi 66,25%, nO gidi 33,75%.
Ldy truyin: qua dutag mdu 40%, dutag tinh dye 53,75%. Sd BN d giai doan b?nh tiln
159
CHUYfeN B6: H$l NGHI KHKT CAC TINH VONB DUYSN HAI BAC Bp LAN THO NHAT triln 72,5%. Cdc benh mdc kem vdi ti 1? cao:
viSm gan B 10 %, viem gan C 38,75%, lao 42,5%, nam 47,5%.
2. Ddnh gid hifu qud sd' dung thuoc ARV - 92,5 - 96,25% benh nhan tudn thu dilu trj > 95%
- Dilu trj bdng ARV cd hifu qua rd rft tren dap irng mien djch va dap tag lam sang (tdng can 47.5- 60%, NTCH mdc mdi 1,25 - 5%, chi so CD4 trung binh tdng them 131,18 dpn vj).
- ADR : ti le gdp ADR giam dan theo thdi gian (50% :33.75% : 18,75%) nhung d mirc do ndng han. Tu khdi 12,82%, diing thudc 69,23%, thay ddi phdc dd 17,95%. Cdc CO quan thudng bj tdn thuang: da, he tieu hda, gan, he TKTW, TK ngoai bien, he tao mau, ca, rdi loan lipid.
VI. KIEN NGH!
- Can duy tri cdng tae tu vdn, gidm sat va hd trp dieu trj de dat dupc hieu qud cao trpng dieu tri.
Benh vien can ddp tap them nhilu Duac sT lam sang de gdp phan nang cao hieu qud dieu trj cho ngudi bfnh ndi ehung va cho benh nhan HIV/AIDS ndi rieng.
- Tang cudng lipp tac qudc te nhdm ndng cao trinh dp chuyen mdn chp ddi ngu edn bp y te va tranh thii su hd tra v l c a sd vft chdt, thudc men, sinh pham trpng edng tde dilu trj cho benh nhan HIV/AIDS tai Hai Phdng.
TAI UEU THAM K H A O
1 Bf Y te (2009), Huang ddn chdn doan ia diiu iri HIV/AIDS, NXB Y hpc.
2. Bf Y te - Cue phdng chong HIV/AIDS Vift Nam (2012), Bdo cao tinh hinh nhiim HIV/AIDS ndm 2011.
3. Bf Y te (2011), Quyet djnh siia ddi bdxmg mOl so noi dung irong « Huang ddn ch&i doan VCI diiu Iri HIV/AIDS »
4. Dirffng Thj Hirong, Pham Thj Hanh PbOc, Tran Thj Bich Hoi (2011), "Kien thiic, thai dp, thirc hanh ve ART d benh nhan mV/AIDS tal phdng kham ngoji trii VIJI Tifp, Hal Phong ». Hoi nghi khoa hgc cong ngh? ldn Ihir XVI, tr.114 - 115, truang dai lipc Y Hal Phong.
5. Hoang Thj Kim HuyIn (2010), Cham soc Dive NXB Y hpc.
6. Andrea A. Kim, PhD (2010), CurrenI slalus of HIV incidence sia-veillance in PEPFAR supporled counlries. MPH Global AIDS
Program US CDC, Atlanta, OA.
7. Harvard Medical School AIDS Initiative in Vietnam (2a08>. Hepalic Toxicity in palienis lakingARV.
8. Harvard IVIedical School AIDS Initiative in Vietnam (2008), Long lerm side effecis of ARV.
9. WHO Library Cataloguing in Publicatinn Data (2010), Aniiren-oviral Iherapyfor HIV infeclion in adulls and adolescents:
recomniendalioiis for a public health approach, Austria.
BANG CHtl CAI VIET TAT
Acquired immuno deficiency syndrome-Hoi chtaq suy qIam mien dich mac phal Antiretroviral - thuoc khanq retrovirus
Human immunodeflclencv virus - Virut gay suy qIam mlln dich d nqUdl Nhiem triing eg hoi
Te bao lympho TCD4
