Hepatitis B and long-term HIV outcomes in coinfected HAART recipients.
Hepatitis B and long-term HIV outcomes in coinfected HAART recipients.
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DOI：
10.1097/qad.0b013e32832e463a
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发表时间：
2009-09-10
期刊：
影响因子：
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通讯作者：
Thio CL
中科院分区：
文献类型：
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作者：
Hoffmann CJ;Seaberg EC;Young S;Witt MD;D'Acunto K;Phair J;Thio CL
慢性乙型肝炎(CH-B)在HIV感染者中很常见，在缺乏高效抗逆转录病毒治疗(HAART)的情况下，它会增加与肝脏相关的死亡率。CH-B对HAART长期结局的影响尚未完全确定。为了解决这个问题，对参加多中心艾滋病队列研究(MACS)的HAART启动者进行了回顾性分析。受试者在HAART开始时根据血清学按乙肝类别进行分类。用回归分析评估CH-B与死亡率、艾滋病定义疾病、CD4升高和HIV抑制之间的关系。在接受抗逆转录病毒治疗的816名男性中，350人从未感染过乙肝病毒，357人有过感染史，45人有乙肝病毒携带者，只有核心抗体阳性。尽管进行了HAART，与艾滋病相关的死亡仍是最常见的死亡原因(8.3/1000人年(Pys))。CHB感染者最高(17/1000 Pys，95%CI 7.3，42)，未感染HBV者最低(2.9/1000 Pys，95%CI 1.4，6.4)。在多变量模型中，与未感染的患者相比，感染CH-B的患者的艾滋病相关死亡率高2.7倍(P=0.08)。非艾滋病相关死亡率在慢性乙型病毒性肝炎患者中也是最高的(22/1000 Pys)，主要是由于肝病(与从未感染的调整后的HR 4.1相比，p=0.04)。在艾滋病定义事件、HIV RNA抑制和CD4升高方面没有显著差异。在接受长期HAART的HIV感染患者中，乙肝病毒状态不影响HIV抑制或CD4升高。然而，在CH-B患者中死亡率最高，尽管HBVHAART活性很高，但主要是由于肝脏疾病。
Chronic hepatitis B (CH-B) is common among HIV-infected individuals and increases liver-related mortality in the absence of highly active antiretroviral therapy (HAART). The impact of CH-B on long-term HAART outcomes has not been fully characterized. To address this question, HAART initiators enrolled in the Multicenter AIDS Cohort Study (MACS) were retrospectively analyzed. Subjects were classified by hepatitis B category based on serology at the time of HAART initiation. The association of CH-B with mortality, AIDS defining illnesses, CD4 rise, and HIV suppression was assessed using regression analysis. Of 816 men followed for a median of 7 years on HAART, 350 were never HBV infected, 357 had past infection, 45 had CH-B, and 64 were only core-antibody positive. Despite HAART, AIDS-related mortality was the most common cause of death (8.3/1000 person-years (PYs)). It was highest in those with CH-B (17/1000 PYs, 95% CI 7.3, 42) and lowest among never HBV infected (2.9/1000 PYs, 95% CI 1.4, 6.4). In a multivariable model, patients with CH-B had a 2.7-fold higher incidence of AIDS-related mortality compared to those never infected (P=0.08). Non-AIDS-related mortality was also highest among those with CH-B (22/1000 PYs), primarily due to liver disease (compared to never infected, adjusted HR 4.1, p=0.04). There was no significant difference in AIDS defining events, HIV RNA suppression, and CD4 increase. In HIV-infected patients receiving long-term HAART, HBV status did not influence HIV suppression or CD4 increase. However, mortality was highest among those with CH-B and was mostly due to liver disease despite HBV-active HAART.