HIV, hepatitis B virus, and hepatitis C virus co-infection in patients in the China National Free Antiretroviral Treatment Program, 2010-12: a retrospective observational cohort study.
HIV, hepatitis B virus, and hepatitis C virus co-infection in patients in the China National Free Antiretroviral Treatment Program, 2010-12: a retrospective observational cohort study.
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DOI：
10.1016/s1473-3099(14)70946-6
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发表时间：
2014-11
期刊：
影响因子：
--
通讯作者：
Shang H
中科院分区：
文献类型：
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作者：
Zhang F;Zhu H;Wu Y;Dou Z;Zhang Y;Kleinman N;Bulterys M;Wu Z;Ma Y;Zhao D;Liu X;Fang H;Liu J;Cai WP;Shang H
在接受抗逆转录病毒联合治疗的艾滋病毒/艾滋病患者中，与肝炎相关的肝脏疾病是导致死亡和发病的主要原因。我们评估了中国患者中B型肝炎病毒（HBV）和丙型肝炎病毒（HCV）合并感染对HIV结局的影响。我们利用2010-11年中国国家免费抗逆转录病毒治疗项目的数据进行了一项全国性回顾性观察性队列研究。年龄大于18岁的患者开始标准抗逆转录病毒治疗HIV，并对HBV和HCV检测呈阳性，随访至2012年12月31日。我们使用Kaplan-Meier分析和考克斯比例风险模型来评估生存率，并使用逻辑回归模型来估计病毒学失败、免疫应答和继续护理。33861例HIV患者符合合格标准。2958例（8.7%）受试者合并HBV感染，6149例（18.2%）合并HCV感染，1114例（3.3%）合并三重感染。三重感染（校正风险比1.90，95%CI 1.53 - 2.37）和HCV合并感染（1.46，1.25 - 1.70）的受试者的全因死亡率高于仅感染HIV的受试者，但HBV合并感染的受试者的全因死亡率并不高（1.06，0.89 - 1.26）。三重感染者也比仅感染HIV者更容易发生病毒学失败（调整后的比值比[OR] 1.26，95%CI 1.02 - 1.56），而HBV合并感染者（0.93，0.80 - 1.10）或HCV合并感染者（1.10，0.97 - 1.26）的差异不显著。治疗1年后，无合并感染与CD 4细胞计数差异显著相关。与仅感染HIV的受试者相比，三重感染（OR 1.37，95%CI 1.16 - 1.62）和HCV合并感染（1.30，1.17 - 1.45）的受试者中失访更常见，但HBV合并感染（0.93，0.82 - 1.05）的受试者中无失访。筛查病毒性肝炎是重要的个人诊断为艾滋病毒阳性。病毒性肝炎的有效管理应纳入艾滋病毒治疗方案。需要关于肝炎合并感染对HIV疾病进展影响的长期数据。中国疾病预防控制中心国家艾滋病性病预防控制中心。
Hepatitis-related liver diseases are a leading cause of mortality and morbidity among people with HIV/AIDS taking combination antiretroviral therapy. We assessed the effect of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on HIV outcomes in patients in China. We did a nationwide retrospective observational cohort study with data from the China National Free Antiretroviral Treatment Program from 2010–11. Patients older than 18 years starting standard antiretroviral therapy for HIV who had tested positive for HBV and HCV were followed up to Dec 31, 2012. We used Kaplan-Meier analysis and Cox proportional hazard models to evaluate survival, and logistic regression models to estimate virological failure, immunological response, and retention in care. 33 861 patients with HIV met eligibility criteria. 2958 (8·7%) participants had HBV co-infection, 6149 (18·2%) had HCV co-infection, and 1114 (3·3%) had triple infection. All-cause mortality was higher in participants with triple infection (adjusted hazard ratio 1·90, 95% CI 1·53–2·37) and HCV co-infection (1·46, 1·25–1·70) than in those with HIV only, but not in those with HBV co-infection (1·06, 0·89–1·26). People with triple infection were also more likely to have virological failure (adjusted odds ratio [OR] 1·26, 95% CI 1·02–1·56) than were those with HIV only, whereas the difference was not significant for those with HBV co-infection (0·93, 0·80–1·10) or HCV co-infection (1·10, 0·97–1·26). No co-infection was significantly associated with a difference in CD4 cell count after 1 year of treatment. Loss to follow-up was more common among participants with triple infection (OR 1·37, 95% CI 1·16–1·62) and HCV co-infection (1·30, 1·17–1·45), but not HBV co-infection (0·93, 0·82–1·05), than among those with HIV only. Screening for viral hepatitis is important in individuals diagnosed as HIV positive. Effective management for viral hepatitis should be integrated into HIV treatment programmes. Long-term data are needed about the effect of hepatitis co-infection on HIV disease progression. The National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention.