Prevalence of hepatitis B co-infection and response to antiretroviral therapy among HIV-infected patients in Tanzania-猫眼课题宝

DOI：

10.1097/qad.0b013e32835cb9c8

发表时间：

2013-03-27

期刊：

AIDS

影响因子：

3.8

通讯作者：

中科院分区：

医学2区

文献类型：

作者：

Hawkins, Claudia;Christian, Beatrice;Fawzi, Wafaie

目的：评估在坦桑尼亚城市接受抗逆转录病毒治疗(ART)的HIV感染成人队列中HIV/乙肝病毒(HBV)混合感染的流行率及其与健康结局的关系。设计/方法：纵向比较2004年11月至2011年9月在坦桑尼亚达累斯萨拉姆的管理和发展(MDH)-PEPFAR HIV护理和治疗项目登记的HIV单项感染(HIV)和HIV/乙肝合并感染(HIV/HBV)成人对ART的临床和免疫学反应。与HIV患者相比，HIV/HBV患者更有可能是男性，更年轻，在ART开始时免疫抑制更严重。HIV和HIV/乙肝患者的中位抗逆转录病毒治疗时间分别为18.6[四分位数范围4.9~29.5]个月和18.2个月(IQR 4.2~27.2)个月。在多变量分析中，艾滋病毒/乙肝患者的死亡风险呈上升趋势(危险比1.18[95%可信区间(CI)0.98-1.42]，P=0.07)，恢复期间CD_4(+)细胞计数降低(P&lt；0.01)，中到重度肝毒性的风险增加(丙氨酸转氨酶120和200 IU/L的P值均为0.01)。接受非替诺福韦(TDF)抗逆转录病毒治疗的HIV/乙肝患者与接受非替诺福韦(TDF)抗逆转录病毒治疗的HIV患者相比，死亡风险更高[风险比1.28(95%可信区间1.02-1.61)，P&lt；0.03]，而HIV/乙肝患者与接受TDF抗逆转录病毒治疗的HIV患者的死亡风险没有差异[风险比0.70(95%可信区间0.34-1.44)，P&lt；0.33]；交互作用P=0.30。结论：在坦桑尼亚HIV感染人群中，乙肝病毒合并感染显著影响ART预后。还需要进一步的研究来证实在这些环境下TDF对艾滋病毒/乙肝病毒混合感染者死亡率的潜在有益影响。(C)2013 Wolters Kluwer Health|Lippincott Williams&Wilkins AIDS 2013，27：919-927

Objectives: To evaluate the prevalence of HIV/hepatitis B virus (HBV) co-infection and relationship between HIV/HBV and health outcomes in a cohort of HIV-infected adults receiving antiretroviral treatment (ART) in urban Tanzania.Design/methods: Clinical and immunologic responses to ART were compared longitudinally between HIV mono (HIV) and HIV/HBV co-infected (HIV/HBV) adults enrolled between November 2004 and September 2011 at the Management and Development for Health (MDH)-PEPFAR HIV Care and Treatment program in Dar es Salaam, Tanzania.Results: The prevalence of HIV/HBV co-infection was 6.2% (1079/17 539). Compared to HIV patients, HIV/HBV patients were more likely to be male, younger, and more immunosuppressed at ART initiation. Median ART duration was 18.6 [interquartile range (IQR) 4.9-29.5] and 18.2 (IQR 4.2-27.2) months in HIV and HIV/HBV patients, respectively. In multivariate analyses, a trend towards a higher risk of mortality was observed in HIV/HBV patients {hazard ratio 1.18 [95% confidence interval (CI) 0.98-1.42], P = 0.07} as well as lower CD4(+) cell counts throughout recovery (P < 0.01) and higher risk of moderate-to-severe hepatotoxicity (P values < 0.01 for alanine transaminase > 120 and > 200 IU/l). There was a higher risk of mortality in HIV/HBV patients vs. HIV patients on non-tenofovir (TDF)-containing ART [hazard ratio 1.28 (95% CI 1.02-1.61), P < 0.03], whereas there was no difference in the risk of mortality observed in HIV/HBV patients vs. HIV patients on TDF-containing ART [hazard ratio 0.70 (95% CI 0.34-1.44), P < 0.33]; interaction P = 0.30.Conclusions: HBV co-infection significantly impacted ART outcomes in this Tanzanian HIV-infected population. Further research is needed to confirm the potential beneficial effects of TDF on mortality in HIV/HBV co-infected individuals in these settings. (c) 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins AIDS 2013, 27:919-927

Prevalence of hepatitis B co-infection and response to antiretroviral therapy among HIV-infected patients in Tanzania

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