Liver fibrosis on account of chronic hepatitis C is more severe in HIV-positive than HIV-negative patients despite antiretroviral therapy
Liver fibrosis on account of chronic hepatitis C is more severe in HIV-positive than HIV-negative patients despite antiretroviral therapy
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DOI：
10.1111/j.1365-2893.2007.00962.x
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发表时间：
2008-06-01
影响因子：
2.5
通讯作者：
Soriano, V.
中科院分区：
文献类型：
--
作者：
de Ledinghen, V.;Barreiro, P.;Soriano, V.
最近可用的非侵入性工具来测量肝纤维化，允许检查其程度并确定所有慢性丙型肝炎病毒（HCV）感染患者的预测因子。另一方面，大多数关于HCV/人类免疫缺陷病毒（HIV）合并感染患者肝纤维化的信息来自于高效抗逆转录病毒治疗（HAART）广泛应用之前的肝活检。对过去3年中观察到的转氨酶升高的所有连续HCV患者进行评估，并使用瞬时弹性成像（FibroScan（R））和生化指标测量肝纤维化。患者根据其HIV血清状态进行分组。共有656例（69.6%）HCV单一感染和287例（30.4%）HIV/HCV合并感染的患者进行了评估。合并感染患者的平均CD 4计数为493个细胞/μ L，88%接受HAART治疗（平均时间为4.2 +/- 2.4年）。39%的合并感染患者和18%的单一感染患者出现晚期肝纤维化或肝硬化（P < 0.005）。FibroScan（R）与生化指标[AST/血小板比值指数（r = 0.405，P < 0.0001）、FIB-4（r = 0.393，P < 0.0001）和Forns（r = 0.407，P < 0.0001）]之间存在良好的相关性，无论HIV状态如何。在多变量分析中，年龄> 45岁、体重指数（BMI）> 25 kg/m2和HIV感染与晚期肝纤维化或肝硬化独立相关。尽管HAART具有免疫学益处，但HIV/HCV合并感染的患者比HCV单一感染的患者有更严重的肝纤维化。
The recent availability of non-invasive tools to measure liver fibrosis has allowed examination of its extent and determination of predictors in all patients with chronic hepatitis C virus (HCV) infection. On the other hand, most information on hepatic fibrosis in HCV/human immunodeficiency virus (HIV)-coinfected patients has been derived from liver biopsies taken before highly active antiretroviral therapy (HAART) was widely available. All consecutive HCV patients with elevated aminotransferases seen during the last 3 years were evaluated and liver fibrosis measured using transient elastography (FibroScan (R)) and biochemical indexes. Patients were split according to their HIV serostatus. A total of 656 (69.6%) HCV-monoinfected and 287 (30.4%) HIV/HCV-coinfected patients were assessed. Mean CD4 count of coinfected patients was 493 cells/mu L and 88% were under HAART (mean time, 4.2 +/- 2.4 years). Advanced liver fibrosis or cirrhosis was recognized in 39% of the coinfected and 18% of the monoinfected patients (P < 0.005). A good correlation was found between FibroScan (R) and biochemical indexes [AST to platelet ratio index (r = 0.405, P < 0.0001), FIB-4 (r = 0.393, P < 0.0001) and Forns (r = 0.407, P < 0.0001)], regardless of the HIV status. In the multivariate analysis, age > 45 years, body mass index (BMI) > 25 kg/m(2), and HIV infection were independently associated with advanced liver fibrosis or cirrhosis. HIV/HCV-coinfected patients have more advanced liver fibrosis than HCV-monoinfected patients despite the immunologic benefit of HAART.