Human immunodeficiency and hepatitis virus infections and their associated conditions and treatments among people with haemophilia.
Human immunodeficiency and hepatitis virus infections and their associated conditions and treatments among people with haemophilia.
复制标题
血友病患者的人体免疫缺陷和肝炎病毒感染及其相关病症和治疗。
DOI：
10.1111/j.1365-2516.2004.00997.x
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Sherman,KE
中科院分区：
文献类型：
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作者：
Goedert,JJ;Brown,DL;Hoots,K;Sherman,KE
1990年前使用受污染的血浆制品治疗导致人类免疫缺陷病毒(HIV)和乙型和丙型肝炎病毒(乙肝病毒、丙型肝炎病毒)的异常流行。在2001-03年间的第二次多中心血友病队列研究(MHCS-II)中，30%的丙型肝炎病毒血清阳性幸存者携带艾滋病毒，4.6%为乙肝病毒携带者。高效抗逆转录病毒疗法(HAART)从根本上改变了艾滋病毒/丙型肝炎病毒混合感染的后果。虽然以前机会性感染占主导地位，但目前的主要并发症是肝功能衰竭和出血(凝血因子合成减少、脾功能亢进、血小板减少和食道静脉曲张加剧)。在MHC-II中，大多数HIV阳性者为HIVRNA阴性，并有 >； 200 CD_4+细胞 µL−1，但只有59%的人在HAART上。HIV感染者，特别是41 岁以后，肝脏疾病明显(黄疸5%，腹水7%，肝大9%，脾大19%)。HAART可提高存活率，但也可能导致各种并发症。在没有艾滋病毒的情况下，联合使用聚乙二醇化干扰素和利巴韦林可以在>； 中获得持续的丙型肝炎病毒清除50%，但在血友病人群中，特别是携带艾滋病毒的人群中的数据有限。在MHCS-II中，标准干扰素加利巴韦林治疗后，丙型肝炎病毒RNA阴性率为41%；在未服用干扰素的参与者中(意味着自发的丙型肝炎病毒清除)，丙型肝炎病毒RNA阴性率为12%，而不使用艾滋病毒的患者为25%。在没有艾滋病毒的情况下，感染时年龄较早，特别是最近出生(20世纪70年代末或80年代初)，丙型肝炎病毒自发清除的可能性要大得多，但出血倾向或其治疗不会。大多数参与者(72%)没有接受过抗丙型肝炎病毒治疗。未来几年，除非大多数成年血友病患者成功治疗艾滋病毒和/或丙型肝炎病毒，否则肝脏和血液病的情况可能会增加。
Treatment with contaminated plasma products before 1990 resulted in extraordinary prevalence rates of human immunodeficiency virus (HIV) and hepatitis B and C viruses (HBV, HCV). In the Second Multicentre Haemophilia Cohort Study (MHCS‐II) during 2001–03, 30% of HCV‐seropositive survivors had HIV and 4.6% were HBV carriers. Highly active antiretroviral therapy (HAART) radically altered the consequences of HIV/HCV coinfection. Whereas opportunistic infections predominated previously, current major complications are liver failure and bleeding (exacerbated by decreased clotting factor synthesis, hypersplenic thrombocytopenia, and oesophageal varices). Most HIV‐positives in MHCS‐II were HIV RNA‐negative and had > 200 CD4+cells µL−1, but only 59% were on HAART. With HIV, especially after 41 years of age, liver disease was apparent (jaundice in 5%, ascites 7%, hepatomegaly 9%, splenomegaly 19%). HAART increases survival but may contribute to various comorbidities. Without HIV, sustained HCV clearance is obtained in > 50% with combined pegylated interferons plus ribavirin, but data in haemophilic populations, especially with HIV, are limited. In MHCS‐II, HCV RNA negativity was 41% following standard interferon plus ribavirin; among interferon‐naïve participants (implying spontaneous HCV clearance), HCV RNA negativity was 12% with and 25% without HIV. Without HIV, spontaneous HCV clearance was much more likely with early age at infection and particularly with recent birth (late 1970s or early 1980s) but not with bleeding propensity or its treatment. Most (72%) participants had received no anti‐HCV therapy. Hepatic and haematological conditions are likely to increase during the coming years unless most adult haemophiliacs are successfully treated for HIV, HCV or both.