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
计量
- 文章访问数: 442
- HTML全文浏览量: 284
- PDF下载量: 52
- 被引次数: 0
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

HTML全文

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)]

下载: 全尺寸图片幻灯片

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

下载: 全尺寸图片幻灯片

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。

下载: 导出CSV

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。

下载: 导出CSV

参考文献(15)

WHO. HIV/AIDS, Key facts[EB/OL]. (2019-07-25)[ 2020-04-12]. https://www.who.int/en/news-room/fact-sheets/detail/hiv-aids.

WHO. Hepatitis C, Key facts[EB/OL]. (2019-07-09)[ 2020-04-12]. https://www.who.int/en/news-room/fact-sheets/detail/hepatitis-c.

Platt L, Easterbrook P, Gower E, et al. Prevalence and burden of HCV co-infection in people living with HIV: a global systematic review and meta-analysis[J]. Lancet Infect Dis, 2016, 16(7):797-808. DOI: 10.1016/S1473-3099(15)00485-5.

Benhammou V, Tubiana R, Matheron S, et al. HBV or HCV coinfection in HIV-1-infected pregnant women in France: prevalence and pregnancy outcomes[J]. J Acquir Immune Defic Syndr, 2018, 77(5):439-450. DOI: 10.1097/QAI.0000000000001618.

Mena A, Meijide H, Rodríguez-Osorio I, et al. Liver-related mortality and hospitalizations attributable to chronic hepatitis C virus coinfection in persons living with HIV[J]. HIV Med, 2017, 18(9):685-689. DOI: 10.1111/hiv.12502.

豆智慧, 张福杰, 赵燕, 等. 2002－2014年中国免费艾滋病抗病毒治疗进展[J].中华流行病学杂志, 2015, 36(12):1345-1350. DOI: 10.3760/cma.j.issn.0254-6450.2015.12.005

Dou ZH, Zhang FJ, Zhao Y, et al. Progress on China's national free antiretroviral therapy strategy in 2002-2014[J]. Chin J Epidemiol, 2015, 36(12):1345-1350. DOI: 10.3760/cma.j.issn.0254-6450.2015.12.005.

Willis SJ, Cole SR, Westreich D, et al. Chronic hepatitis C virus infection and subsequent HIV viral load among women with HIV initiating antiretroviral therapy[J]. AIDS, 2018, 32(5):653-661. DOI: 10.1097/QAD.0000000000001745.

钟敏, 李娅, 何增品, 等.昆明地区HIV-HCV共感染人群基因型耐药突变的特点[J].昆明医科大学学报, 2019, 40(4):126-130. DOI: 10.3969/j.issn.1003-4706.2019.04.026.

Zhong M, Li Y, He ZP, et al. Study on the Characteristics of genotypic drug resistance mutation in HIV-HCV co-infected population in Kunming[J]. Journal of Kunming Medical University, 2019, 40(4):126-130. DOI: 10.3969/j.issn.1003-4706.2019.04.026.

Silva CMD, Peder LD, Silva ES, et al. Impact of HBV and HCV coinfection on CD4 cells among HIV-infected patients: a longitudinal retrospective study[J]. J Infect Dev Ctries, 2018, 12(11):1009-1018. DOI: 10.3855/jidc.10035.

国家卫生健康委员会.艾滋病和艾滋病病毒感染诊断: WS293-2019[S].北京: 中国标准出版社, 2019.

National Health Commission of the People's Republic of China. Diagnosis for HIV/AIDS: WS293-2019[S]. Beijing: Standards Press of China, 2019.

中华医学会肝病学分会, 中华医学会感染病学分会.丙型肝炎防治指南(2015更新版)[J].中华肝脏病杂志, 2015, 23(12):906-923. DOI: 10.3760/cma.j.issn.1007-3418.2015.12.003.

Chinese Society of Hepatology, Chinese Medical Association, Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for hepatitis C: a 2015 update[J]. Chin J Hepatol, 2015, 23(12):906-923. DOI: 10.3760/cma.j.issn.1007-3418.2015.12.003.

Martinello M, Amin J, Matthews GV, et al. Prevalence and disease burden of HCV coinfection in HIV cohorts in the Asia Pacific Region: A systematic review and meta-analysis[J]. AIDS Rev, 2016, 18(2):68-80.

王继宝, 陈晓晨, 段星, 等.云南省德宏州2016-2017年新报告中国和缅甸籍HIV感染者中HCV的流行病学特征[J].中华疾病控制杂志, 2019, 23(10):1293-1296, 1300. DOI: 10.16462/j.cnki.zhjbkz.2019.10.026

Wang JB, Chen XC, Duan X, et al. Epidemiological characteristics of co-infection of hepatitis C virus among newly reported HIV infected patients in Chinese and Burmese from 2016 to 2017 in Dehong Prefecture of Yunnan Province[J]. Chin J Dis Control Prev, 2019, 23(10):1293-1296, 1300. DOI: 10.16462/j.cnki.zhjbkz.2019.10.026.

Schlabe S, Rockstroh JK. Advances in the treatment of HIV-HCV coinfection in adults[J]. Expert Opin Pharmacother, 2018, 19(1):49-64. DOI: 10.1080/14656566.2017.1419185.

葛琳, 李东民, 李培龙, 等. 2010-2015年中国艾滋病哨点监测人群HIV、梅毒和HCV感染状况分析[J].疾病监测, 2017, 32(2):111-117. DOI: 10.3784/j.issn.1003-9961.2017.02.008.

Ge L, Li DM, Li PL, et al. Population specific sentinel surveillance for HIV infection, syphilis and HCV infection in China, during 2010-2015[J]. Dis Surveill, 2017, 32(2):111-117. DOI: 10.3784/j.issn.1003-9961.2017.02.008.

施引文献

资源附件(0)

访问统计