Prevalence of hepatitis B and C viruses in HIV-positive patients in China: a cross-sectional study
Prevalence of hepatitis B and C viruses in HIV-positive patients in China: a cross-sectional study
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DOI：
10.7448/ias.19.1.20659
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发表时间：
2016-03-14
影响因子：
6
通讯作者：
Li, Taisheng
中科院分区：
文献类型：
--
作者：
Xie, Jing;Han, Yang;Li, Taisheng
简介：与乙型肝炎 (HBV) 和丙型肝炎 (HCV) 相关的肝病可能会影响中国抗逆转录病毒治疗 (ART) 的成功。关于其在艾滋病毒阳性中国人中的流行率的数据有限。开展了一项多中心、横断面研究，以确定12个省份HIV阳性患者中HBV和HCV合并感染的患病率和疾病特征。方法：从2008年11月至2010年1月和2012年8月至2014年9月建立的两个父队列中招募未接受过ART治疗的HIV阳性患者。乙型肝炎表面抗原（HBsAg）、乙型肝炎e抗原和HCV抗体在开始 ART 之前，从父母数据库中检索（抗 HCV）状态。然后测定 HBsAg + 患者的 HBV-DNA。对抗 HCV + 患者的 HCV-RNA 进行定量。计算天冬氨酸转氨酶与血小板比率指数（APRI）和纤维化-4（FIB4）。酌情采用卡方检验、Kruskal-Wallis检验和逻辑回归进行统计分析。结果：1944例HIV阳性患者中，186例（9.5%）HIV-HBV合并感染，161例（8.3%）HIV-HCV合并感染。 HIV-HBV 患病率最高（14.5%）在华东地区，HIV-HCV 患病率最高在中部地区（28.2%）。 HIV-HBV 患者的 CD4 + T 细胞计数中位数（205 个细胞/μL）低于 HIV 单一感染者（242 个细胞/μL，P = 0.01）或 HIV-HCV 患者（274 个细胞/μL，P = 0.001）。超过 65% 的 HIV-HCV 患者存在中度至重度肝病，与 35% 的 HIV-HBV 患者和 20% 的 HIV 单一感染患者相似。基于 APRI 的中度至重度肝病的独立关联包括 HBV（比值比，OR 2.37，P < 0.001）、HCV（OR 9.64，P < 0.001）、CD4 计数 = 30 年（OR 1.80，P = 0.001）。结论：中国 HIV 阳性人群中 HBV 和 HCV 患病率较高，且因地理区域而异。 HBV 和 HCV 混合感染以及 HIV 单一感染是中度至重度肝病的风险。只有 HIV-HBV 与更强的 HIV 相关免疫抑制相关。需要将肝炎病毒感染的筛查和管理纳入中国的艾滋病规划。
Introduction: Liver disease related to hepatitis B (HBV) and hepatitis C (HCV) may temper the success of antiretroviral therapy (ART) in China. Limited data exist on their prevalence in HIV-positive Chinese. A multi-centre, cross-sectional study was carried out to determine the prevalence and disease characteristics of HBV and HCV co-infection in HIV-positive patients across 12 provinces.Methods: HIV-positive ART-naive patients were recruited from two parent cohorts established during November 2008-January 2010 and August 2012-September 2014. Hepatitis B surface antigen (HBsAg), hepatitis B e antigen and HCV antibody (anti-HCV) status were retrieved from parent databases at the visit prior to ART initiation. HBV-DNA was then determined in HBsAg + patients. HCV-RNA was quantified in anti-HCV + patients. Aspartate aminotransferase-to-platelet ratio index (APRI) and the fibrosis-4 (FIB4) were calculated. Chi-square test, Kruskal-Wallis test and logistic regression were used for statistical analysis, as appropriate.Results: Of 1944 HIV-positive patients, 186 (9.5%) were HIV-HBV co-infected and 161 (8.3%) were HIV HCV co-infected. The highest HIV-HBV prevalence (14.5%) was in Eastern China while the highest HIV-HCV prevalence was in the Central region (28.2%). HIV-HBV patients had lower median CD4 + T cell count (205 cells/mu L) than either HIV monoinfected (242 cells/mu L, P = 0.01) or HIV-HCV patients (274 cells/mu L, P = 0.001). Moderate-to-significant liver disease was present in >65% of the HIV-HCV, similar to 35% of the HIV-HBV and similar to 20% of the HIV monoinfected patients. Independent associations with moderate-to- significant liver disease based on APRI included HBV (Odds ratio, OR 2.37, P < 0.001), HCV (OR 9.64, P < 0.001), CD4 count = 30 years (OR 1.80, P = 0.001).Conclusions: HBV and HCV prevalence is high in HIV-positive Chinese and differs by geographic region. HBV and HCV co-infection and HIV monoinfection are risks for moderate-to-significant liver disease. Only HIV-HBV is associated with greater HIV-related immunosuppression. Incorporating screening and management of hepatitis virus infections into Chinese HIV programmes is needed.