Yee T T, Griffioen A, Sabin C A, Dusheiko G, Lee C A
Haemophilia Centre and Haemostasis Unit, Royal Free Hospital, London, UK.
Gut. 2000 Dec;47(6):845-51. doi: 10.1136/gut.47.6.845.
This study describes the long term follow up of haemophilic patients infected with hepatitis C virus (HCV) between 1961 and 1985.
Clinical and treatment records from 310 patients with inherited coagulation disorders treated with blood product before 1985 were reviewed. Standard survival analysis methods were used to model progression to liver failure and death.
A total of 298/305 (98%) patients tested were anti-HCV positive. Twenty seven (9%) individuals consistently HCV polymerase chain reaction negative were considered to have cleared the virus. By 1 September 1999, 223/310 (72%) were alive, 26 (8%) had died a liver related death, and 61 (20%) had died from other, predominantly human immunodeficiency virus (HIV) related, causes. Kaplan-Meier progression rates to death from any cause and liver related deaths 25 years after exposure to HCV were 47% (95% confidence intervals (CI) 34-60) and 19% (95% CI 10-27), respectively. After 13.3 years from 1985, by which time all patients had seroconverted to HIV, progression rates to death from any cause and liver related deaths were, respectively, 8% (95% CI 4-13) and 3% (95% CI 0.4-6) for those HIV negative, and 57% (95% CI 48-66) and 21% (95% CI 13-31) for those HIV positive (p=0.0001). Using Cox proportional hazard models, the adjusted relative hazard of death for individuals coinfected with HIV compared with those infected with HCV alone was 19.47 (95% CI 9.22-41.10), 0.99 (95% CI 0.39-2.53), 3.47 (95% CI 1.40-8.63), and 9.74 (95% CI 3.91-24.26) for the age groups at infection 10-19 years, 20-29 years, and >30 years, respectively, compared with the age group <10 years. The adjusted relative hazard for genotype 1 compared with other genotypes was 2.7 (95% CI 1.36-5.15).
While 25 year follow up of 310 haemophilic patients has shown the potentially lethal combination of HIV and HCV coinfection, HCV singly infected individuals show slow progression of liver disease.
本研究描述了1961年至1985年间感染丙型肝炎病毒（HCV）的血友病患者的长期随访情况。
回顾了1985年前接受血液制品治疗的310例遗传性凝血障碍患者的临床和治疗记录。采用标准生存分析方法对肝衰竭进展和死亡情况进行建模。
共检测了305例患者，其中298例（98%）抗-HCV阳性。27例（9%）HCV聚合酶链反应持续阴性的个体被认为已清除病毒。截至1999年9月1日，310例患者中有223例（72%）存活，26例（8%）死于与肝脏相关的疾病，61例（20%）死于其他原因，主要是与人类免疫缺陷病毒（HIV）相关的原因。接触HCV 25年后，任何原因导致的死亡和与肝脏相关的死亡的Kaplan-Meier进展率分别为47%（95%置信区间（CI）34 - 60）和19%（95% CI 10 - 27）。从1985年起13.3年后，此时所有患者均已血清转化为HIV阳性，对于HIV阴性的患者，任何原因导致的死亡和与肝脏相关的死亡的进展率分别为8%（95% CI 4 - 13）和3%（95% CI 0.4 - 6），而对于HIV阳性的患者，分别为57%（95% CI 48 - 66）和21%（95% CI 13 - 31）（p = 0.0001）。使用Cox比例风险模型，与仅感染HCV的个体相比，合并感染HIV的个体在感染时年龄组为10 - 19岁、20 - 29岁和>30岁时，调整后的相对死亡风险分别为19.47（95% CI 9.22 - 41.10）、0.99（95% CI 0.39 - 2.53）、3.47（95% CI 1.40 - 8.63）和9.74（95% CI 3.91 - 24.26），与年龄组<10岁相比。与其他基因型相比，基因型1的调整后相对风险为2.7（95% CI 1.36 - 5.15）。
对310例血友病患者进行25年的随访显示，HIV和HCV合并感染具有潜在致命性，而单独感染HCV的个体肝病进展缓慢。
