Interactions Between HIV and HCV in Coinfected Hemophiliacs

血源性病原体丙型肝炎病毒（HCV）和艾滋病毒的联合感染在血友病患者和静脉注射吸毒者中极为常见。虽然HCV感染是美国肝脏移植的主要原因，但大多数感染者不会发展为有症状的肝脏疾病。虽然对同时感染HIV和HCV的个体进行的队列研究表明，同时感染会增加肝功能衰竭的风险，但目前尚不清楚HCV同时感染如何影响HIV-1进展的自然史。因此，我们启动了一项调查，在一项研究中探索这些病原体之间的相互作用，该研究对参与1989- 1990年血友病生长与发展研究的207名hiv感染者和121名未感染HCV感染的血友病患者进行了研究。在基线和7年随访期间，共有332名血友病患者每年重复进行1-8次HCV RNA检测。所有受试者每年检测CD4+细胞和血浆HCV RNA， HIV感染者每年检测血浆HIV RNA。采用第二代Chiron bDNA测定法定量HIV和HCV RNA水平。不出所料，我们发现hiv感染儿童的基线HCV RNA高于未感染组（p=0.0001）。我们还观察到基线CD4+细胞数、HIV RNA和HCV RNA之间存在显著相关性：较高的CD4 T细胞绝对值与较低的HCV RNA相关，而较高的HCV RNA与较高的HIV病毒载量密切相关。我们还发现HCV病毒载量与艾滋病进展率之间存在显著关联：在控制HIV RNA、CD4 + T细胞和抗病毒治疗后，基线HCV RNA每增加10倍，进展为艾滋病的相对危险度增加1.60。我们还观察到合并HIV感染的儿童的HCV清除率明显较低。该研究表明，HCV是HIV临床进展的独立预测因子，并建议在合并感染患者中研究降低HCV病毒载量的治疗干预措施。血友病患者HIV和HCV的相互作用

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. Although cohort studies of individuals coinfected with both HIV and HCV have shown that coinfection increases the risk of liver failure, it is not known 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 levels were quantified 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. We also found a significant association between HCV viral load and rate of progression to AIDS: 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. We also observed that HCV clearance rates are significantly lower in children with HIV coinfection. This study demonstrates that HCV is an independent predictor of HIV clinical progression and suggests that therapeutic interventions to lower HCV viral load should be investigated in coinfected patients. Interactions Between HIV and HCV in Hemophiliacs