Hepatitis C and progression of HIV disease
Hepatitis C and progression of HIV disease
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DOI：
10.1001/jama.288.2.199
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发表时间：
2002-07-10
影响因子：
120.7
通讯作者：
Thomas, DL
中科院分区：
文献类型：
--
作者：
Sulkowski, MS;Moore, RD;Thomas, DL
丙型肝炎病毒（HCV）对人类免疫缺陷病毒（HIV）疾病进展的影响已有相关报道。目的评估HCV感染对HIV疾病临床和免疫学进展以及对高效抗逆转录病毒治疗（HAART）的免疫应答的影响。设计前瞻性队列研究。在1995年1月至2001年1月期间，招募了1955名患者，这些患者由于至少有一次回访诊所并且在招募时没有获得性免疫缺陷综合征（AIDS）而有资格进行分析。中值（四分位距）随访时间为2.19（1.00-3.50）岁的HCV感染和2.00（1.00-3.00）年（对于HCV未感染的患者）。主要结果测量进展到AIDS定义疾病、存活率和进展到CD 4细胞计数低于200/穆尔;开始有效HAART治疗后的CD 4细胞计数变化结果在获得艾滋病定义疾病的风险方面没有发现差异（HCV感染者231例，发生率26.4%; HCV未感染者264例，发生率24.4%;相对危险度1.03; 95%置信区间[CI]，0.86-1.23）或死亡风险（HCV感染患者，153例死亡[17.5%]，HCV未感染患者，168例死亡[15.5%]; RH，1.05; 95% CI，0.85-1.30）。尽管在429例基线CD 4细胞计数为50/μ L至200/μ L的HCV感染患者的亚组中检测到死亡风险增加，（相对湿度，1.51; 95%CI，1.01-2.27），在多变量考克斯回归分析中，调整HAART暴露及其有效性后，该亚组中死亡与HCV感染无关（RH，1.01; 5% Cl，0.65-1.56）。同样，在接受有效HAART治疗的患者中（n=208），HCV感染者HAART治疗期间CD 4细胞计数或CD 4百分比的增加与HCV未感染患者相比无差异。结论在美国城市队列患者中，我们没有发现HCV感染实质上改变死亡、发展为艾滋病或对HAART免疫反应的风险的证据。特别是在考虑到其管理和有效性方面的差异之后。
Context Conflicting reports exist regarding the effect of hepatitis C virus (HCV) on the progression of human immunodeficiency virus (HIV) disease.Objective To assess the effect of HCV infection on clinical and immunologic progression of HIV disease and immunologic response to highly active antiretroviral therapy (HAART).Design Prospective cohort study.Setting University-based, urban HIV clinic in the United States.Patients There were 1955 patients enrolled between January 1995 and January 2001 who were eligible for analysis because of having at least 1 return visit to the clinic and being free of acquired immunodeficiency syndrome (AIDS) at enrollment. Median (interquartile range) length,of follow-up was 2.19 (1.00-3.50) years for HCV-infected and 2.00 (1.00-3.00) years for HCV-uninfected patients.Main Outcome Measures Progression to an AIDS-defining illness, survival, and progression to a CD4 cell count below 200/muL; CD4 cell count change following initiation of effective HAART (resulting in a viral load of = 75% of measurements).Results No difference was detected in the risk of acquiring an AIDS-defining illness (HCV-infected patients, 231,events [26.4%] and HCV-uninfected patients, 264 events [24.4%]; relative hazard [RH], 1.03; 95% confidence interval [CI], 0.86-1.23) or in the risk of death (HCV-infected patients, 153 deaths [17.5%] and HCV-uninfected patients, 168 deaths [15.5%]; RH, 1.05; 95% Cl, 0.85-1.30). Although an increased risk of death was detected in the subgroup of 429 HCV-infected patients with a baseline CD4 cell count of 50/mu L through 200/mu L (RH, 1.51; 95% Cl, 1.01-2.27), after adjustment for exposure to HAART and its effectiveness in a multivariate Cox regression analysis, death was not independently associated with HCV infection in this subgroup (RH, 1.01; 5% Cl, 0.65-1.56). Similarly, in those receiving effective HAART (n=208), there was no difference in the increase in CD4 cell count or CD4 percentage during HAART in HCV-infected compared with HCV-uninfected patients.Conclusions Among patients in this urban US cohort, we did not detect evidence that HCV infection substantially alters the risk of dying, developing AIDS, or responding immunologically to HAART, especially after accounting for differences in its administration and effectiveness.