成都市HCV合并感染对HIV/AIDS抗病毒治疗效果的影响

段振华; 奚静; 代珍; 范双凤; 吴学庆; 何勤英

doi:10.16462/j.cnki.zhjbkz.2020.12.008

成都市HCV合并感染对HIV/AIDS抗病毒治疗效果的影响

doi: 10.16462/j.cnki.zhjbkz.2020.12.008

610041 成都, 成都市疾病预防控制中心性病与艾滋病防制科

基金项目:

四川省医学科研课题计划 S19059

详细信息

通讯作者:
何勤英，E-mail：hqysi@163.com

中图分类号: R181;R512.91
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出版历程
- 收稿日期: 2020-04-18
- 修回日期: 2020-07-25
- 刊出日期: 2020-12-10

The highly active antiretroviral therapy effect among HIV/AIDS patients with and without HCV coinfection in Chengdu City

Department of AIDS/STD Control and Prevention, Chengdu Center for Disease Control and Prevention, Chengdu 610041, China

Funds:

Sichuan Medical Scientific Research Program S19059

More Information

Corresponding author: HE Qin-ying, E-mail:hqysi@163.com

摘要

摘要: 目的了解艾滋病病毒(human immunodeficiency virus, HIV)-丙型肝炎病毒(hepatitis C virus, HCV)合并感染者和HIV感染者艾滋病(acquired immunedeficiency syndrome, AIDS)抗病毒治疗(Antiretroviral therapy, ART)的效果，并进一步分析HCV合并感染对艾滋病ART效果的影响。方法利用国家艾滋病综合防治信息系统选取成都市2010年1月1日至2018年12月31日确诊的HIV/AIDS病例信息，随访时间截至2019年12月31日。采用Cox比例风险模型分析HCV感染对艾滋病ART病毒学失败的影响。结果符合纳入标准的HIV-HCV合并感染者共555例，另匹配HIV感染者555例。在接受艾滋病抗病毒治疗4年内，HIV感染组和HIV-HCV合并感染组CD4⁺T淋巴细胞计数(简称CD4)的中位数年均分别升高45.9个/mm³、37.1个/mm³。两组病例累计随访2 393.1人年，病毒学失败率为7.15/100人年(171/2 393.1)。多因素Cox分析结果显示，HIV-HCV合并感染组发生病毒学失败的风险是HIV感染组的1.512(1.042~2.195)倍(P=0.030)。结论合并HCV感染可能是影响HIV/AIDS艾滋病抗病毒治疗效果的危险因素。
- HIV /
- 丙型肝炎 /
- 合并感染 /
- 抗病毒治疗
Abstract: Objective This study aimed to analyze the impact of hepatitis C virus (HCV) coinfection on antiretroviral therapy(ART) effect with human immunodeficiency virus (HIV), and examine the impact of HCV coinfection on CD4⁺T cells count (CD4) and virologic failure (VF) in patients with HIV. Methods All data were extracted from the National HIV/AIDS (human immunodeficiency virus /acquired immunodeficiency syndrome) Comprehensive Response Information Management System. Information were collected from HIV-HCV coinfection patients who diagnosed with HIV during 2010-2018, with follow-up conducted till December 31, 2019. Cox proportional hazard model was used to analyze the factors associated with VF after ART. Results 555 HIV-HCV coinfection patients and matched another 555 HIV monoinfection patients were included. An increased CD4 cell count was observed in all groups within 4 years of receiving ART treatment, the average annual increase in the HIV monoinfection group and HIV-HCV co-infection group were 45.9 cells/mm³ and 37.1 cells/mm³ for the median CD4 cell counts. 171 individuals experienced VF with an incidence rate of 7.15 per 100 person-years. The multivariate Cox proportional hazard analysis showed that the HIV-HCV coinfection group was associated with increased hazard of VF (aHR=1.512, 95% CI: 1.042-2.195, P=0.030) compared to HIV monoinfection group. Conclusion HIV-HCV coinfection was significantly associated with increased hazard of VF during highly active antiretroviral therapy for HIV/AIDS.
- HIV /
- HCV /
- Antiretroviral Therapy /
- Virologic failure

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图 1 两组接受艾滋病抗病毒治疗后CD4中位数M(P₂₅，P₇₅)的变化趋势

Figure 1. The change trend of the median CD4 after receiving antiretroviral therapy in HIV-HCV coinfection and HIV monoinfection groups [M(P₂₅, P₇₅)]

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图 2 HIV-HCV合并感染组与HIV感染组艾滋病抗病毒治疗病毒学失败发生率

Figure 2. The incidence of virological failure in HIV-HCV coinfection and HIV monoinfection groups

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表 1 HIV-HCV合并感染组与HIV感染组的基本情况

Table 1. Baseline characteristics of HIV-HCV co-infection and HIV monoinfection groups

变量	HIV感染组	HIV-HCV合并感染组	t/χ²值	P值
HIV确诊时年龄[岁，(x±s)]	39.66±14.26	40.63±13.54	1.161	0.246
婚姻状况			2.567	0.463
未婚	194	169
已婚或同居	207	222
离异/分居/丧偶	144	153
不详	10	11
传播途径			159.67	< 0.001
注射吸毒或采(输)血传播	8	138
同性性传播	147	61
异性性传播	388	332
不详或其他	12	24
HIV确诊到治疗时间(d)			46.419	< 0.001
0~	145	155
31~	124	215
≥366	286	185
WHO临床分期			4.160	0.245
Ⅰ	231	202
Ⅱ	185	201
Ⅲ	99	116
Ⅳ	40	36
ALT (U/L)			44.371	< 0.001
0~	424	320
≥40	124	219
缺失	7	16
AST(U/L)			95.055	< 0.001
0~	464	316
≥40	81	204
缺失	10	35
基线CD4(个/mm³)			11.758	0.019
0~	196	212
200~	178	206
350~	100	84
≥500	79	49
缺失	2	4
初始治疗方案			55.268	< 0.001
TDF+3TC+EFV/NVP	496	412
AZT/D4T+3TC+EFV/NVP	35	121
其他	24	22
注：ALT:丙氨酸氨基转移酶；AST:天门冬氨酸氨基转移酶；TDF：替诺福韦；3TC：拉米夫定；AZT：齐多夫定；D4T：司他夫定；NVP：奈韦拉平；EFV：依非韦伦。

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表 2 成都市HIV/AIDS抗病毒治疗病毒学失败的影响因素分析

Table 2. The multiple factors analysis for Cox regression model of virologic failure among HIV/AIDS patients on ART in Chengdu City

变量	β	s_x	Wald值	aHR (95% CI)值	P值
基线CD4(个/mm³)
0~				1.000	0.008
200~	-0.421	0.182	5.350	0.656(0.460~0.938)	0.021
350~	-0.258	0.236	1.197	0.772(0.486~1.227)	0.274
≥500	-1.108	0.377	8.644	0.330(0.158~0.691)	0.003
AST(U/L)
0~				1.000
≥40	0.219	0.217	1.015	1.245(0.813~1.905)	0.314
ALT(U/L)
0~				1.000
≥40	0.029	0.210	0.019	1.029(0.682~1.554)	0.890
HIV确诊到治疗时间(d)
0~				1.000	0.689
31~	0.159	0.209	0.580	1.173(0.778~1.768)	0.446
≥366	0.115	0.212	0.293	1.121(0.741~1.698)	0.588
是否合并HCV感染
否				1.000
是	0.414	0.190	4.732	1.512(1.042~2.195)	0.030
初始治疗方案
TDF+3TC+EFV/NVP				1.000
其他方案	0.360	0.219	2.692	1.433(0.932~2.204)	0.101
传播途径
性传播与其他				1.000
注射吸毒或采(输)血传播	0.385	0.218	3.123	1.469(0.959~2.252)	0.077
注：ALT:丙氨酸氨基转移酶；AST:天门冬氨酸氨基转移酶；TDF：替诺福韦；3TC：拉米夫定；NVP：奈韦拉平；EFV：依非韦伦。

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