Impact of hepatitis C virus coinfection on response to highly active antiretroviral therapy and outcome in HIV-infected individuals: A Nationwide Cohort Study
Impact of hepatitis C virus coinfection on response to highly active antiretroviral therapy and outcome in HIV-infected individuals: A Nationwide Cohort Study
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DOI：
10.1086/503569
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发表时间：
2006-05-15
影响因子：
11.8
通讯作者：
Obel, N
中科院分区：
文献类型：
--
作者：
Weis, N;Lindhardt, BO;Obel, N
背景。人类免疫缺陷病毒（HIV） 1型感染患者合并丙型肝炎病毒（HCV）可能会降低高活性抗逆转录病毒治疗的有效性。我们确定了HCV感染对丹麦HIV-1感染患者对高效抗逆转录病毒治疗的反应和转归的影响。这项前瞻性队列研究包括1995年1月1日至2004年1月1日开始高活性抗逆转录病毒治疗的所有成年丹麦hiv -1感染患者。患者分为HCV阳性（HCV血清学检测和/或HCV PCR结果阳性[443例{16%}]）、HCV阴性（HCV血清学检测结果一致阴性[2183例{80%}]）和HCV- u（从未检测过HCV[108例{4%}]）。研究终点是病毒载量、CD4（+）细胞计数和死亡率。与丙型肝炎病毒阴性组相比，丙型肝炎病毒阳性组的总死亡率显著高于阴性组（死亡率比为2.4；95%可信区间[CI]为1.9-3.0），肝脏疾病相关死亡率也显著高于阴性组（死亡率比为16；95%可信区间[CI]为7.2-33）。此外，hcv阳性组患者因凝血酶原时间< 0.3、获得性免疫缺陷综合征相关疾病以及有酗酒史而死亡的风险更高。虽然我们观察到hcv阳性组和hcv阴性组之间的病毒载量没有差异，但hcv阳性组的CD4（+）细胞绝对计数略低。hiv - hcv合并感染患者对高活性抗逆转录病毒治疗的反应受到损害。总体死亡率，以及肝脏相关和获得性免疫缺陷综合征相关原因的死亡率，在这一患者组中显著增加。
Background. Coinfection with hepatitis C virus (HCV) in human immunodeficiency virus (HIV) type 1 infected patients may decrease the effectiveness of highly active antiretroviral therapy. We determined the impact of HCV infection on response to highly active antiretroviral therapy and outcome among Danish patients with HIV-1 infection.Methods. This prospective cohort study included all adult Danish HIV-1-infected patients who started highly active antiretroviral therapy from 1 January 1995 to 1 January 2004. Patients were classified as HCV positive (positive HCV serological test and/or HCV PCR results [443 patients {16%}]), HCV negative (consistent negative HCV serological test results [2183 patients {80%}]) and HCV-U (never tested for HCV [108 patients {4%}]). The study end points were viral load, CD4(+) cell count, and mortality.Results. Compared with the HCV-negative group, overall mortality was significantly higher in the HCV-positive group ( mortality rate ratio, 2.4; 95% confidence interval [CI], 1.9-3.0), as was liver disease-related mortality (mortality rate ratio, 16; 95% CI, 7.2-33). Furthermore, patients in the HCV-positive group had a higher risk of dying with a prothrombin time < 0.3, from acquired immunodeficiency syndrome-related disease, and if they had a history of alcohol abuse. Although we observed no difference in viral load between the HCV-positive and HCV-negative groups, the HCV-positive group had a marginally lower absolute CD4(+) cell count.Conclusions. HIV-HCV-coinfected patients are compromised in their response to highly active antiretroviral therapy. Overall mortality, as well as mortality from liver-related and acquired immunodeficiency syndrome-related causes, is significantly increased in this patient group.