Ramos Paesa C, Pascual Catalán A, Arazo Garcés P, Aguirre Errasti J M, Lasierra P
Servicio de Medicina Interna, Hospital Miguel Servet, Zaragoza.
An Med Interna. 1998 Sep;15(9):464-9.
To know the clinical implications of the viremia level and its evolution in time of the hepatitis C virus (HCV) in patients with chronic hepatitis and infected with the Human Immunodeficiency Virus (HIV).
We have studied the viremia level of the HCV in a a 38 patients group with active chronic hepatitis and infected with the HIV, using a quantitative PCR technic (Amplicor HCV, Roche Diagnostics); we had histological data in 33 of these patients. In 20 patients was analyzed the evolution in time of the viremia level with two or three serialized measurements (20 and 10 patients respectively), throughout 7.5 and 14.8 months on the average. We have analyzed some aspects like the risky behaviors associated with transmission, the estimated time from the contagious, the degree of histological damage and the immunitary impairment.
We have observed a tendency to present a higher viremia level (logarithmic expression) with longer evolution time from the infection (p = 0.08). The viral load had an inverse relation with the degree of histological fibrosis (Light fibrosis: 4.5 +/- 0.8 log vs Severe fibrosis: 3.7 +/- 0.8 log) (p < 0.01) and a direct relation with the Knodell histological activity index (HAI), only with those patients with a lower fibrosis degree (p < 0.01). There was no relation between the viremia level of the HCV and the degree of immunosuppression measured by the CD4 lymphocyte count, at least in those patients in which it was higher than 200/mm3. We have not observed relations between the viral load and the age or the transaminases level. The evolution in time of the viremia tended to rise from 3.7 +/- 1.3 to 4.5 +/- 0.9 log in 14.8 months on the average, although there were some cases with tendency to decrease. We have not observed relation between its increase/month and the degree of histological damage or the CD4 lymphocyte count.
The viral load of the HCV in HIV-infected patients seems to have an inverse relation with the degree of liver fibrosis and direct relation with the histological activity when the fibrosis light and so it could indirectly inform us about the liver aggression. The degree of immunosuppression measured by the CD4 lymphocyte count, when these are > 200/mm3, doesn't seem to influence the viremia level of the HCV. The evolution of the viral load in time tend to rise although there could be some cases with intermittent or descending evolution, without these tendencies have any clinical implications.
了解慢性肝炎患者感染人类免疫缺陷病毒（HIV）时丙型肝炎病毒（HCV）病毒血症水平及其随时间的变化情况的临床意义。
我们使用定量PCR技术（Amplicor HCV，罗氏诊断公司）研究了38例患有活动性慢性肝炎且感染HIV的患者的HCV病毒血症水平；其中33例患者有组织学数据。对20例患者进行了两次或三次系列测量（分别为20例和10例患者）以分析病毒血症水平随时间的变化，平均持续7.5个月和14.8个月。我们分析了一些方面，如与传播相关的危险行为、从感染算起的估计时间、组织学损伤程度和免疫损害情况。
我们观察到从感染算起时间越长，病毒血症水平（对数表达）有升高的趋势（p = 0.08）。病毒载量与组织学纤维化程度呈负相关（轻度纤维化：4.5 +/- 0.8 log vs 重度纤维化：3.7 +/- 0.8 log）（p < 0.01），与Knodell组织学活动指数（HAI）呈正相关，仅在纤维化程度较低的患者中如此（p < 0.01）。HCV病毒血症水平与通过CD4淋巴细胞计数测量的免疫抑制程度之间无相关性，至少在那些CD4淋巴细胞计数高于200/mm3的患者中如此。我们未观察到病毒载量与年龄或转氨酶水平之间的相关性。病毒血症随时间的变化平均在14.8个月内倾向于从3.7 +/- 1.3升至4.5 +/- 0.9 log，尽管有一些病例有下降倾向。我们未观察到其每月升高幅度与组织学损伤程度或CD4淋巴细胞计数之间的相关性。
HIV感染患者中HCV的病毒载量似乎与肝纤维化程度呈负相关，在轻度纤维化时与组织学活动呈正相关，因此它可以间接告知我们肝脏受侵袭的情况。当通过CD4淋巴细胞计数测量的免疫抑制程度大于200/mm3时，似乎不会影响HCV的病毒血症水平。病毒载量随时间的变化倾向于升高，尽管可能有一些病例有间歇性或下降性变化，且这些倾向无任何临床意义。
