Hepatitis C coinfection increases the risk of fulminant hepatic failure in patients with HIV in the HAART era
Hepatitis C coinfection increases the risk of fulminant hepatic failure in patients with HIV in the HAART era
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DOI：
10.1016/j.jhep.2004.11.017
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发表时间：
2005-03-01
影响因子：
25.7
通讯作者：
El-Serag, HB
中科院分区：
文献类型：
--
作者：
Kramer, JR;Giordano, TP;El-Serag, HB
背景/目的：与单纯感染艾滋病毒的患者相比，合并感染丙型肝炎和HIV的患者是否更有可能发生暴发性肝功能衰竭(FHF)尚不确定。方法：我们使用退伍军人事务部的国家行政数据库对1991年10月至2000年9月首次住院的艾滋病毒和/或丙型肝炎患者进行了一项回溯性队列研究。暴发性肝功能衰竭被定义为在没有既往肝病的情况下，在指数住院后至2001年9月发生。我们计算了发病率、Kaplan Meier累积发病曲线和Cox比例风险比，同时调整了人口统计学和其他潜在的混杂因素。结果：我们确定了11,678名单独感染HIV的患者和4761名合并感染的患者。仅HIV感染者组和混合感染者组暴发性肝功能衰竭92例，发病率分别为1.1/1000人年和2.5/1000人年。合并感染组暴发性肝衰竭的累积发生率高于单独感染艾滋病毒组(P<；0.0001)。在HAART时代，与仅感染HIV的患者相比，HAART时代合并感染的患者暴发性肝功能衰竭的风险是HAART之前的几倍。结论：在HIV感染的患者中，HAART和丙型肝炎似乎协同作用，增加了暴发性肝功能衰竭的风险，暴发性肝功能衰竭是一种罕见但往往是致命的疾病。(C)2004年欧洲肝脏研究协会。爱思唯尔出版，版权所有。
Background/Aims: It is uncertain if patients coinfected with hepatitis C and HIV are more likely to suffer fulminant hepatic failure (FHF) when compared to patients with HIV-only.Methods: We conducted a retrospective cohort study using national administrative databases from the Department of Veterans Affairs in patients hospitalized for the first time with HIV and/or hepatitis C between 10/1991 and 9/2000. Fulminant hepatic failure was defined as occurring after the index hospitalization through 9/2001 in the absence of preexisting liver disease. We calculated incidence rates, Kaplan Meier cumulative incidence curves, and Cox proportional hazards ratios while adjusting for demographics and other potential confounders.Results: We identified 11,678 patients with HIV-only and 4761 patients with coinfection. There were 92 cases of fulminant hepatic failure yielding an incidence rate of 1.1/1000 person-years and 2.5/1000 person-years in the HIV-only and coinfected groups. The cumulative incidence of fulminant hepatic failure in the coinfected group was higher than in the HIV-only group (P < 0.0001). The risk of fulminant hepatic failure in patients with coinfection compared to HIV-only during the HAART era was several folds higher than that during the pre-HAART era.Conclusions: HAART and hepatitis C coinfection appeared to act synergistically in HIV-infected patients to increase the risk of fulminant hepatic failure, a rare but often fatal disease. (c) 2004 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.