Clinical outcomes of hepatitis B virus coinfection in a United States cohort of hepatitis C virus-infected patients.
Clinical outcomes of hepatitis B virus coinfection in a United States cohort of hepatitis C virus-infected patients.
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DOI：
10.1002/hep.27337
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发表时间：
2014-12
期刊：
影响因子：
13.5
通讯作者：
Kanwal, Fasiha
中科院分区：
文献类型：
--
作者：
Kruse, Robert L.;Kramer, Jennifer R.;Tyson, Gia L.;Duan, Zhigang;Chen, Liang;El-Serag, Hashem B.;Kanwal, Fasiha
乙型肝炎病毒（HBV）合并感染对丙型肝炎病毒（HCV）患者的影响尚不清楚。我们使用国家退伍军人事务HCV临床病例登记处来识别1997-2005年间确诊的HCV病毒血症患者。我们将HBV合并感染定义为乙型肝炎表面抗原、HBV DNA或乙型肝炎e抗原检测阳性。我们根据验证的ICD9代码定义肝硬化和HCC，并确定到2009年底的死亡率。我们进行了Cox比例风险回归分析，以检验HBV DNA状态（阳性或阴性）分层的HBV合并感染对肝硬化、HCC和死亡风险的影响，并根据患者的年龄、性别、种族、HIV感染、酒精或药物使用、Deyo评分和抗病毒治疗进行调整。在99548例HCV感染患者中，1370例（1.4%）合并HBV感染。在合并感染的患者中，677例（49.4%）患者至少进行了一次HBV DNA检测，303例（44.7%）患者HBV DNA检测呈阳性。合并HBV感染和可检测HBV DNA的患者的肝硬化、HCC和死亡发生率明显高于单一HCV感染患者（每1000人年分别为36.8、6.9和41.7比17.4、3.6和31.4，所有比较均p<0.05）。在调整了人口统计学、临床和治疗因素后，检测到HBV DNA的患者发生肝硬化（危险比[HR] =1.89, 95%CI= 1.46-2.45）、HCC （HR=2.12, 95%CI= 1.26-3.60）和死亡（HR=1.62, 95%CI= 1.33-1.99）的风险明显高于单一HCV感染的患者。HBV DNA检测不出的合并感染患者与单一HCV感染患者发生肝硬化、HCC或总死亡率的风险无差异（hr =1.18, 95% CI= 0.90-1.55; 1.54, 95% CI= 0.93-2.56; 1.08, 95% CI= 0.88-1.33）。总之，我们发现，虽然只有少数HCV患者合并感染HBV，但记录在案的HBV病毒血症患者发生肝硬化、HCC和总体死亡的风险明显高于单纯感染HCV的患者。HBV复制缺失与单一HCV感染患者的临床病程相似。
The effect of hepatitis B virus (HBV) co-infection in patients with hepatitis C virus (HCV) remains unclear. We used the National Veterans Affairs HCV Clinical Case Registry to identify patients with confirmed HCV viremia during 1997–2005. We defined HBV co-infection as a positive test for hepatitis B surface antigen, HBV DNA, or hepatitis B e antigen. We defined cirrhosis and HCC based on the validated ICD9 codes and determined mortality through the end of 2009. We performed Cox proportional hazard regression analyses to examine the effect of HBV co-infection stratified by HBV DNA status (positive or negative) on the risk of cirrhosis, HCC, and death adjusting for patients’ age, gender, race, HIV infection, alcohol or drug use, Deyo Score, and antiviral treatment. Among 99,548 patients with HCV infection, 1370 patients (1.4%) had HBV co-infection. Of the co-infected patients, 677 (49.4%) patients had at-least 1 HBV DNA test done and 303 patients (44.7%) tested positive for HBV DNA. The incidence rates of cirrhosis, HCC, and death were significantly higher in patients with HBV co-infection and detectable HBV DNA compared to HCV mono-infection (36.8, 6.9, and 41.7 versus 17.4, 3.6, and 31.4 per 1,000 person-years, respectively; p<0.05 for all comparisons). After adjustment for demographic, clinical, and treatment factors, patients with detectable HBV DNA had a significantly higher risk for cirrhosis, (hazard ratio [HR] =1.89 95% CI=1.46–2.45), HCC (HR=2.12, 95%CI=1.26–3.60), and death (HR=1.62, 95%CI=1.33–1.99), respectively, compared to HCV mono-infected patients. There were no differences in the risk of cirrhosis, HCC, or overall mortality between co-infected patients with undetectable HBV DNA and those with HCV mono-infection (HRs=1.18, 95% CI=0.90–1.55; 1.54, 95% CI=0.93–2.56; 1.08, 95% CI=0.88–1.33, respectively). In conclusion, we found that while only a small number of HCV patients were co-infected with HBV, patients with documented HBV viremia were at a significantly higher risk for cirrhosis, HCC, and overall death than HCV mono-infected patients. Absence of HBV replication was associated with a clinical course similar to that of HCV mono-infected patients.
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影响因子：
120.7
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