More improvement than progression of liver fibrosis following antiretroviral therapy in a longitudinal cohort of HIV-infected patients with or without HBV and HCV co-infections
More improvement than progression of liver fibrosis following antiretroviral therapy in a longitudinal cohort of HIV-infected patients with or without HBV and HCV co-infections
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DOI：
10.1111/jvh.12658
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发表时间：
2017-05-01
影响因子：
2.5
通讯作者：
He, N.
中科院分区：
文献类型：
--
作者：
Ding, Y.;Duan, S.;He, N.
我们研究了联合抗逆转录病毒治疗（cART）对合并或不合并乙型肝炎（HBV）或丙型肝炎病毒（HCV）感染的hiv感染患者肝纤维化的影响。这是一项2004-2016年期间接受cART治疗的hiv感染患者的回顾性队列研究。采用纤维化-4 （FIB-4）评分评估肝纤维化，分为三类：1级，3.25级。在3900名参与者中，68.6%为单HIV感染，5.3%为HIV/HBV合并感染，23.8%为HIV/HCV合并感染，2.3%为HIV/HBV/HCV合并感染。参与者接受随访治疗（中位数为3.3年）。第2类（52.6%）和第3类（74.2%）分别改善到较低的一类。1级和2级患者分别有12.8%和5.0%进展到更高级别，中位时间为5.7个月。对于较低级别的改善，年龄较大，男性，傣族，注射药物使用，HCV合并感染和替诺福韦治疗是阴性预测因素，但在FIB-4的第3类和时间更新后的CD4计数从基线增加是阳性预测因素。对于进展到更高级别，年龄较大，男性，景伯族和HCV合并感染是阳性预测因子，而基线CD4计数和FIB-4的2级是阴性预测因子。在3级患者中，改善到较低级别与死亡风险降低相关。对于合并或不合并肝炎感染的艾滋病毒感染者，早期启动cART可能会减轻或减缓一些肝纤维化，但应特别注意那些年龄较大、男性和合并丙型肝炎感染的患者。
We examined the effect of combination antiretroviral therapy (cART) on liver fibrosis among HIV-infected patients with or without hepatitis B (HBV) or C virus (HCV) co-infection. This was a retrospective cohort study of HIV-infected patients receiving cART during 2004-2016. Liver fibrosis was assessed using Fibrosis-4 (FIB-4) score with three classifications: Class 1, 3.25. Of 3900 participants, 68.6% were HIV mono-infected, 5.3% were HIV/HBV co-infected, 23.8% were HIV/HCV co-infected and 2.3% were HIV/HBV/HCV co-infected. Participants received follow-up treatment (median was 3.3 years). Improvement to a lower class was observed in Class 2 (52.6%) and Class 3 (74.2%), respectively. Progression to a higher class was observed in 12.8% and 5.0% in Class 1 and Class 2, respectively, and with a median time of 5.7 months. For improvement to lower classes, older age, male, Dai ethnicity, injection drug use, HCV co-infection and tenofovir for treatment were negative predictors, but in Class 3 of FIB-4 and time-updated increases in CD4 count from baseline were positive predictors. For progression to higher classes, older age, male, Jingpo ethnicity and HCV co-infection were positive predictors, while baseline CD4 count and in Class 2 of FIB-4 were negative predictors. Improvement to lower class linked with decreased mortality risk among patients in Class 3. Early cART initiation for HIV-infected patients with and without hepatitis co-infections may mitigate or slow down some of liver fibrosis, but special attention should be given to those who are older, male, co-infected with HCV.