Di Martino V, Rufat P, Boyer N, Renard P, Degos F, Martinot-Peignoux M, Matheron S, Le Moing V, Vachon F, Degott C, Valla D, Marcellin P
Service d'Hépatologie, INSERM U481 et Centre de Recherche Claude Bernard sur les Hèpatites Virales, Hôpital Beaujon, Clichy, France.
Hepatology. 2001 Dec;34(6):1193-9. doi: 10.1053/jhep.2001.29201.
In this study we analyzed the influence of human immunodeficiency virus (HIV) infection on the course of chronic hepatitis C through multivariate analysis including age, alcohol consumption, immune status, and hepatitis C virus (HCV)-related virologic factors. Eighty HIV-positive and 80 HIV-negative injection drug users included between 1980 and 1995 were matched according to age, gender, and duration of HCV infection and followed-up during 52 months. The progression to cirrhosis was the primary outcome measure. The impact of HIV on HCV-RNA load, histologic activity index, response to interferon therapy, and liver-related death was also considered. In HIV-positive patients, chronic hepatitis C was characterized by higher serum HCV-RNA levels (P =.012), higher total Knodell score (P =.011), and poorer sustained response to interferon therapy (P =.009). High serum HCV-RNA level was associated with low CD4-lymphocyte count (P =.001). Necroinflamatory score was higher in HIV-positive patients (P =.023) independently of the CD4-lymphocyte count, whereas increased fibrosis was related to decreased CD4-lymphocyte count (P =.011). The progression to cirrhosis was accelerated in HIV-positive patients with low CD4 cell count (RR = 4.06, P =.024) and in interferon-untreated patients (RR = 4.76, P =.001), independently of age at HCV infection (P =.001). Cirrhosis caused death in 5 HIV-positive patients. The risk of death related to cirrhosis was increased in heavy drinkers (RR = 10.8, P =.001) and in HIV-positive patients with CD4 cell count less than 200/mm(3) (RR = 11.9, P =.007). In this retrospective cohort study, HIV coinfection worsened the outcome of chronic hepatitis C, increasing both serum HCV-RNA level and liver damage and decreasing sustained response to interferon therapy. Age and alcohol were cofactors associated with cirrhosis and mortality. Interferon therapy had a protective effect against HCV-related cirrhosis no matter what the patient's HIV status was.
在本研究中，我们通过多因素分析，包括年龄、饮酒量、免疫状态以及丙型肝炎病毒（HCV）相关病毒学因素，分析了人类免疫缺陷病毒（HIV）感染对慢性丙型肝炎病程的影响。选取了1980年至1995年间纳入研究的80名HIV阳性和80名HIV阴性注射吸毒者，根据年龄、性别和HCV感染持续时间进行匹配，并随访52个月。进展为肝硬化是主要的结局指标。还考虑了HIV对HCV-RNA载量、组织学活动指数、干扰素治疗反应以及肝脏相关死亡的影响。在HIV阳性患者中，慢性丙型肝炎的特点是血清HCV-RNA水平较高（P = 0.012）、总Knodell评分较高（P = 0.011）以及对干扰素治疗的持续反应较差（P = 0.009）。高血清HCV-RNA水平与低CD4淋巴细胞计数相关（P = 0.001）。无论CD4淋巴细胞计数如何，HIV阳性患者的坏死性炎症评分均较高（P = 0.023），而纤维化增加与CD4淋巴细胞计数减少相关（P = 0.011）。CD4细胞计数低的HIV阳性患者（相对危险度RR = 4.06，P =
