Prevalence of conditions associated with human immunodeficiency and hepatitis virus infections among persons with haemophilia, 2001-2003.
Prevalence of conditions associated with human immunodeficiency and hepatitis virus infections among persons with haemophilia, 2001-2003.
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2001-2003 年血友病患者中与人体免疫缺陷和肝炎病毒感染相关疾病的患病率。
DOI：
10.1111/j.1365-2516.2005.01138.x
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
SecondMulticenterHemophiliaCohortStudy
中科院分区：
文献类型：
--
作者：
Goedert,JJ;SecondMulticenterHemophiliaCohortStudy
在20世纪80年代中期之前，血友病患者经常在不知情的情况下使用受污染的血浆产品进行治疗，导致人类免疫缺陷病毒（HIV-1）、丙型肝炎病毒（HCV）和B型肝炎病毒（HBV）感染率较高。为了估计这些感染的影响，建立了一个新的队列。52家综合性血友病治疗中心的所有HCV血清阳性患者（年龄13-88岁）均合格。分析了2001年4月至2004年1月（中位数为2002年6月）期间收集的横断面数据。通过聚合酶链反应定量血浆HIV-1和HCV RNA。高效抗逆转录病毒治疗（HAART）被定义为使用至少三种推荐药物。在2069名参与者中，620人（30%）患有HIV-1。在1955例已知HBV状态的患者中，814例（42%）已消退，90例（4.6%）为HBV携带者。虽然80%的HIV-1阳性参与者的CD 4+细胞≥200 μL-1，但只有59%的人接受了HAART治疗。在未服用抗逆转录病毒药物的人群中，23%的人检测不到HIV-1 RNA。大多数（72%）参与者没有接受过抗HCV治疗。在接受标准干扰素联合利巴韦林治疗的受试者中，HCV RNA的检出率较低（59%）（P= 0.0001），而在HIV-1阳性受试者中的检出率高于HIV-1阴性受试者（85% vs. 70%，P <0.0001）。 HIV-1阳性受试者更有可能出现全血细胞减少和亚临床肝脏异常，以及持续性黄疸、肝肿大、脾肿大和腹水。HAART接受者与HIV阴性参与者在腹水患病率方面没有差异。临床异常在年龄较大时更普遍，但不受HBV状态或自我报告饮酒的混淆。11名参与者患有或既往患有肝细胞癌或非霍奇金淋巴瘤。虽然需要前瞻性分析，但我们的数据揭示了未来几年可能在成人血友病人群中出现的肝脏和血液学疾病的规模，除非他们中的大多数人成功治疗HIV-1，HCV或两者兼而有之。
Before the mid‐1980s, haemophilia often was unknowingly treated with contaminated plasma products, resulting in high rates of human immunodeficiency virus (HIV‐1), hepatitis C virus (HCV) and hepatitis B virus (HBV) infections. To estimate the impact of these infections, a new cohort was established. All HCV‐seropositive patients, age 13–88 years, at 52 comprehensive haemophilia treatment centres were eligible. Cross‐sectional data collected during April 2001 to January 2004 (median June 2002) were analysed. Plasma HIV‐1 and HCV RNA were quantified by polymerase chain reaction. Highly active antiretroviral therapy (HAART) was defined as use of at least three recommended medications. Among 2069 participants, 620 (30%) had HIV‐1. Of 1955 with known HBV status, 814 (42%) had resolved HBV and 90 (4.6%) were HBV carriers. Although 80% of the HIV‐1‐positive participants had ≥200 CD4+cellsμL−1, only 59% were on HAART. HIV‐1 RNA was undetectable in 23% of those not taking antiretroviral medications. Most (72%) participants had received no anti‐HCV therapy. HCV RNA was detected less frequently (59%) among participants treated with standard interferon plus ribavirin (P= 0.0001) and more frequently among HIV‐1‐positive than HIV‐1‐negative participants (85% vs. 70%,P< 0.0001). HIV‐1‐positive participants were more likely to have pancytopenia and subclinical hepatic abnormalities, as well as persistent jaundice, hepatomegaly, splenomegaly and ascites. HAART recipients did not differ from HIV‐negative participants in the prevalence of ascites. The clinical abnormalities were more prevalent with older age but were not confounded by HBV status or self‐reported alcohol consumption. Eleven participants presented with or previously had hepatocellular carcinoma or non‐Hodgkin lymphoma. Although prospective analysis is needed, our data reveal the scale of hepatic and haematological disease that is likely to manifest in the adult haemophilic population during the coming years unless most of them are successfully treated for HIV‐1, HCV or both.