Liver damage in patients living with HIV on antiretroviral treatment with normal baseline liver function and without HBV/HCV infection: an 11-year retrospective cohort study in Guangxi, China
Liver damage in patients living with HIV on antiretroviral treatment with normal baseline liver function and without HBV/HCV infection: an 11-year retrospective cohort study in Guangxi, China
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基线肝功能正常且无 HBV/HCV 感染且接受抗逆转录病毒治疗的 HIV 感染者的肝损伤：中国广西的一项 11 年回顾性队列研究
DOI：
10.1136/bmjopen-2018-023140
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发表时间：
2019-06-01
期刊：
影响因子：
2.9
通讯作者：
Liang, Hao
中科院分区：
文献类型：
--
作者：
Qin, Fengxiang;Jiang, Junjun;Liang, Hao
目的 描述在初始基线肝功能正常且无乙型肝炎病毒（HBV）/丙型肝炎病毒（HCV）感染的艾滋病（HIV）患者中，抗逆转录病毒治疗（ART）持续时间与肝损伤之间的关联。方法 在中国广西贵港市，对2004年4月14日至2015年4月13日期间开始接受ART时肝功能参数正常且无HBV/HCV感染的HIV感染者进行了一项回顾性队列研究。分析了ART持续时间与肝损伤（Ⅱ - Ⅳ级肝酶升高[LEE]和/或总胆红素升高[TBE]）之间的关联。采用Cox回归分析与肝损伤相关的因素。结果 在2119例符合条件的患者中，12.41%（263/2119）发生了肝损伤（Ⅱ - Ⅳ级LEE/TBE），粗发病率为4.11/100人年。在接受ART治疗6 - 12个月的患者中肝损伤发生率最高（15.16/100人年）。在接受ART治疗12 - 18个月的患者中，发生率降至5.56/100人年，在接受18 - 24个月治疗的患者中降至3.13/100人年，然后在接受ART治疗2年或更长时间的患者中保持在相对较低且稳定的水平（平均3.65/100人年）。Cox回归分析显示，当前世界卫生组织（WHO）疾病分期为Ⅱ、Ⅲ或Ⅳ期（与Ⅰ期相比）是肝损伤的危险因素，而基线疾病分期为Ⅱ、Ⅲ期（与Ⅰ期相比）以及当前使用的3TC + AZT + NVP方案是肝损伤的保护因素。结论 在接受ART治疗的基线肝功能正常且无HBV/HCV感染的HIV感染者中，肝损伤始终存在。然而，累积的ART持续时间并不会增加肝损伤的风险。ART可以倾向于长期进行，但是，在临床治疗中，对接受ART治疗的患者进行肝损伤的监测和管理也很重要。
Objective To characterise the association between duration of exposure to antiretroviral treatment (ART) and liver damage in HIV patients with an initially normal baseline liver function and without hepatitis B virus (HBV)/hepatitis C virus (HCV) infection. Methods A retrospective cohort study was conducted in HIV-infected individuals with normal liver function parameters at ART initiation and without HBV/HCV infection, from 14 April 2004 to 13 April 2015 in Guigang city, Guangxi, China. The association between duration of ART and liver damage (grade II–IV liver enzyme elevation [LEE] and/or total bilirubin elevation [TBE]), was analysed. Cox regression was used to examine the factors related to liver damage. Results Of 2119 eligible patients, 12.41% (263/2119) developed liver damage (grade II–IV LEE/TBE) and contributed 4.11/100 person-years crude incidence rate. The highest liver damage incidence was observed in patients with 6–12 months’ ART (15.16/100 person-years). The incidence decreased to 5.56/100 person-years in patients with 12–18 months’ ART and 3.13/100 person years in patients with 18–24 months’ ART, and then maintained at a relatively low and stable level in patients with 2 years’ ART or longer (average of 3.65/100 person-years). Cox regression analysis revealed that current WHO disease stage II, III or IV (compared with stage I) were the risk factors for liver damage, while baseline disease stage II, III (compared with stage I) and current regimen 3TC+AZT+NVP were the protective factors for liver damage. Conclusions Liver damage always exists among HIV-infected patients on ART with normal baseline liver function and without HBV/HCV infection. Nevertheless, cumulative ART duration does not increase the risk of liver damage. ART could tend to be long-term, however, monitoring and management of liver damage among patients on ART are also important in clinical therapy.