Rapid fibrosis progression among HIV/hepatitis C virus-co-infected adults
Rapid fibrosis progression among HIV/hepatitis C virus-co-infected adults
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DOI：
10.1097/qad.0b013e3282f10de9
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发表时间：
2007-10-18
期刊：
影响因子：
3.8
通讯作者：
Thomas, David L.
中科院分区：
文献类型：
--
作者：
Sulkowski, Mark S.;Mehta, Shruti H.;Thomas, David L.
目的：确定丙型肝炎病毒(HCV)/HIV合并感染成人中纤维化进展的发生率，评估HCV或HIV治疗是否会改变进展的风险，并确定肝活检对预测未来疾病的效用。设计：该前瞻性队列评估了184例至少进行过两次肝活检（中位间隔2.9年）的HIV/ hcv合并感染者。方法：由单个病理学家对活检顺序不确定，按照Ishak改良的组织活性指数评分系统对活检组织进行评分。显著纤维化进展被定义为在第一次和第二次肝活检之间至少增加两个Ishak纤维化单位。采用Logistic回归分析评估纤维化进展的决定因素。结果：共有174名非肝硬化患者符合条件；其中大多数是正在接受艾滋病治疗的非裔美国男性。在最初的活检中，136例患者（77%）未发现纤维化或纤维化很小。41例（24%）患者出现明显的纤维化进展。在进展者和非进展者中，初始活检前后的HIV疾病测量及其治疗没有显著差异。纤维化进展与HCV治疗无关，37例（21%）患者接受了HCV治疗，但只有3例持续HCV- rna抑制。在校正分析中，只有活检期间血清天冬氨酸转氨酶水平升高与进展相关（奇比3.4,95%可信区间1.4-7.9）。结论：在3年的时间间隔内，即使在最初的活检中检测到最小的疾病，合并感染的个体也可能发生显著的纤维化进展。在这种情况下，HIV或HCV治疗以外的因素会改变纤维化进展的风险。(C) 2007年威科集团（Wolters Kluwer Health）收购Lippincott Williams & Wilkins。
Objectives: To define the incidence of fibrosis progression among hepatitis C virus (HCV)/HIV-co-infected adults, to assess whether HCV or HIV treatment alters the risk of progression, and to determine the utility of liver biopsy to predict future disease.Design: This prospective cohort evaluated 184 HIV/HCV-co-infected individuals who had at least two liver biopsies (median interval 2.9 years).Methods: Biopsies were scored according to the Ishak modified histological activity index scoring system by a single pathologist blind to biopsy sequence. Significant fibrosis progression was defined as an increase of at least two Ishak fibrosis units between the first and second liver biopsy. Logistic regression analysis was used to assess determinants of fibrosis progression.Results: A total of 174 non-cirrhotic patients were eligible; the majority were African-American men undergoing HIV treatment. On initial biopsy, no or minimal fibrosis was identified in 136 patients (77%). Significant fibrosis progression occurred in 41 patients (24%). Measures of HIV disease and its treatment before and after initial biopsy were not significantly different in progressors and non-progressors. Fibrosis progression was not associated with HCV treatment, which was received by 37 patients (21%) but only three sustained HCV-RNA suppression. In adjusted analysis, only an elevated serum aspartate aminotransferase level between biopsies was associated with progression (odd ratio 3.4, 95% confidence interval 1.4-7.9).Conclusion: Over a 3-year interval, significant fibrosis progression can occur in co-infected individuals even if minimal disease was detected on initial biopsy. In this context, factors other than treatment for HIV or HCV modify the risk of fibrosis progression. (C) 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins.