INTERACTIONS BETWEEN HIV AND HCV IN HEMOPHILIACS

由血液传播的病原体丙型肝炎病毒(丙型肝炎病毒)和艾滋病毒混合感染在血友病患者和静脉吸毒者中非常常见。虽然丙型肝炎病毒感染是美国肝移植的主要原因，但大多数感染者不会出现症状性肝病。对同时感染艾滋病毒和丙型肝炎病毒的人群进行的队列研究表明，混合感染会增加肝功能衰竭的风险。然而，目前尚不清楚丙型肝炎病毒混合感染如何影响HIV-1进展的自然历史。因此，我们启动了一项调查，以探索这些病原体之间的相互作用，在一项研究中，207名感染艾滋病毒的血友病患者和121名未感染丙型肝炎病毒的血友病患者在1989-90年间参与了血友病生长和发展研究。共有332名血友病患者在基线和7年随访期间每年重复进行1-8次丙型肝炎病毒核糖核酸检测。所有受试者每年检测CD4+细胞和血浆丙型肝炎病毒核糖核酸，HIV感染者每年检测血浆HIV核糖核酸。用第二代CHIRON BDNA测定仪测定HIV和HCVRNA。不出所料，我们发现艾滋病毒感染儿童的基线HCVRNA高于未感染组(p=0.0001)。我们还观察到基线CD4+细胞数量、HIV RNA和HCVRNA之间存在显著的相关性：高绝对值的CD4T细胞与低的HCVRNA相关，而高的HCVRNA与高的HIV病毒载量密切相关。令人惊讶的是，在控制了艾滋病毒RNA、CD4+T细胞和抗病毒治疗后，基线丙型肝炎病毒RNA每增加10倍，进展为艾滋病的相对风险就增加1.60。这项研究表明，丙型肝炎病毒可能是HIV临床进展的独立预测因子。血友病患者中HIV与丙型肝炎病毒的相互作用--丙型肝炎病毒、HIV-1、艾滋病、血友病患者和人类

Coinfection by the blood borne pathogens hepatitis C virus (HCV) and HIV is extremely common in hemophiliacs and intravenous drug users. Although HCV infection is the leading cause of liver transplants in the United States, most infected individuals do not develop symptomatic liver disease. Cohort studies of individuals coinfected with both HIV and HCV have shown that coinfection increases the risk of liver failure. However, it is unknown how HCV coinfection affects the natural history of HIV-1 progression. We have therefore initiated an investigation to explore the interaction between these pathogens in a study of 207 HIV-infected and 121 uninfected hemophiliacs with HCV infection who were involved in 1989-90 in the Hemophilia Growth and Development Study. A total of 332 hemophiliacs had 1-8 repeated annual HCV RNA measurements between baseline and 7 years of follow-up. CD4+ cells and plasma HCV RNA was measured annually in all subjects, and plasma HIV RNA was measured annually in the HIV-infected subjects. HIV and HCV RNA was measured using second generation Chiron bDNA assays. Not unexpectedly, we found that baseline HCV RNA was higher in HIV- infected children than in uninfected groups (p=0.0001). We have also observed significant correlations between baseline CD4+ cell number, HIV RNA and HCV RNA: higher absolute CD4 T cells were correlated with lower HCV RNA while higher HCV RNA was strongly correlated with high HIV viral load. Surprisingly, after controlling for HIV RNA, CD4 + T cells, and antiviral therapy, for every 10-fold increase in baseline HCV RNA, there was a 1.60 increase in the relative hazard for progression to AIDS. This study suggests that HCV may be an independent predictor of HIV clinical progression. Interactions Between HIV and HCV in Hemophiliacs - HCV, HIV-1, AIDS, Hemophiliacs, - Human Subjects