Proportion and factors associated with Hepatitis B viremia in antiretroviral treatment naive and experienced HIV co-infected Ghanaian patients
Proportion and factors associated with Hepatitis B viremia in antiretroviral treatment naive and experienced HIV co-infected Ghanaian patients
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DOI：
10.1186/s12879-016-1342-4
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发表时间：
2016-01-13
影响因子：
3.7
通讯作者：
Kwara, Awewura
中科院分区：
文献类型：
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作者：
Archampong, Timothy N. A.;Lartey, Margaret;Kwara, Awewura
背景：全球B型肝炎病毒（HBV）和HIV合并感染的负担是巨大的。发生肝硬化和肝细胞癌的风险与HBV DNA水平相关。本研究的主要目的是确定在接受过抗逆转录病毒治疗的加纳患者中，未接受过抗逆转录病毒治疗的患者发生B型肝炎病毒血症的比例，以及在接受拉米夫定联合或不联合含替诺福韦的抗逆转录病毒治疗至少36周后发生HBV病毒血症的相关因素。将未接受过抗逆转录病毒治疗或接受过至少9个月含拉米夫定抗逆转录病毒治疗的B型肝炎和HIV合并感染患者纳入一项交叉研究，在Korle-Bu教学医院进行部分研究。收集人口统计学和临床数据，并获得用于B型肝炎血清学、肝功能检查和HBV DNA的样本。使用单变量和多变量logistic回归分析确定与病毒血症相关的因素。结果：筛选的3108例HIV感染者中，257例（8.3%）为HBsAg阳性，其中235例入组。总体而言，152例（64.7%）患者接受过ART，83例（35.3%）患者未接受过ART。89%的ART初治患者和42.1%的ART经验患者的HBV DNA > 20 IU/mL。在所有患者的多变量分析中，ART初治（OR 10.1，95% CI 4.6 - 21.9）和ALT升高（OR 3.7，95% CI 1.8 - 7.9）与B型肝炎病毒血症相关。在有治疗经验的患者中，ALT升高（OR 4.8 CI 2.0 - 12.1）和男性（OR 2.1，95% CI 1.0 - 4.2）与B型肝炎病毒血症相关。结论：大多数ART初治患者（89%）和42% ART经验丰富的患者可检测到B型肝炎病毒血症> 20 IU/mL。在HBV和HIV合并感染的患者中，血清ALT异常与B型肝炎病毒血症显著相关，与治疗状态无关。在撒哈拉以南非洲资源有限的国家，基线和治疗期间ALT可能是B型肝炎病毒血症的一个有用的非侵入性预测因子，这些国家的感染是地方性的，病毒载量检测并不广泛可用。
Background: The global burden of Hepatitis B virus (HBV) and HIV co-infection is enormous. The risk of developing cirrhosis and hepatocellular cancer is associated with HBV DNA levels. The main objective of the study was to determine proportion of Hepatitis B viremia in ART-naive and ART-experienced co-infected Ghanaian patients and factors associated with HBV viremia after at least 36 weeks of lamivudine with or without tenofovir containing ART.Methods: Hepatitis B and HIV co-infected patients who were ART-naive or had received at least 9 months of lamivudine-containing ART were enrolled in a cross-sectional study at Korle-Bu Teaching Hospital. Demographic and clinical data were collected and samples obtained for Hepatitis B serology, liver function tests and HBV DNA. Factors associated with viremia were determined using univariate and multivariate logistic regression analysis.Results: Of 3108 HIV-infected patients screened, 257 (8.3 %) were HBsAg-positive, of which 235 enrolled. Overall, 152 (64.7 %) were ART-experienced and 83 (35.3 %) were ART-naive. Eighty-nine-percent of ART-naive and 42.1 % of ART-experienced patients had HBV DNA > 20 IU/mL. In multivariate analysis of all patients, being ART-naive (OR 10.1, 95 % CI 4.6 - 21.9) and elevated ALT (OR 3.7, 95 % CI 1.8 - 7.9) were associated with Hepatitis B viremia. In treatment experienced patients, elevated ALT (OR 4.8 CI 2.0 - 12.1) and male sex (OR 2.1, 95 % CI 1.0 - 4.2) were associated with Hepatitis B viremia.Conclusions: Majority of ART-naive (89 %) and 42 % of ART-experienced patients had detectable hepatitis B viremia > 20 IU/mL. An abnormal serum ALT was significantly associated with hepatitis B viremia in HBV and HIV co-infected patients irrespective of treatment status. Baseline and on-treatment ALT may be a useful non-invasive predictor of Hepatitis B viremia in resource-constrained countries in sub-Saharan Africa where infection is endemic and viral load tests are not widely available.