Macías J, Melguizo I, Fernández-Rivera F J, García-García A, Mira J A, Ramos A J, Rivera J M, Pineda J A
Servicio de Medicina Interna, Hospital Universitario de Valme, Ctra Cádiz, s/n, 41014 Seville, Spain.
Eur J Clin Microbiol Infect Dis. 2002 Nov;21(11):775-81. doi: 10.1007/s10096-002-0823-0. Epub 2002 Nov 9.
The aim of the present study was to examine the causes of death, the mortality attributable to liver failure, and the impact of hepatitis virus infections on the survival of a cohort of HIV-infected patients before and after the extensive use of highly active antiretroviral therapy (HAART). Liver disease associated with hepatitis C virus (HCV) seems to be accelerated in patients infected with the human immunodeficiency virus (HIV). On the other hand, the effect of HCV on HIV progression was controversial before the introduction of HAART. However, the last study to report changes in mortality due to liver failure was published in 1997, and the impact of HCV carriage on the survival of HIV-infected patients receiving HAART needs to be clarified. In this investigation, 492 patients who were prescribed antiretroviral drugs between April 1989 and September 2000 were included in the study cohort. The median duration of follow-up of the cohort was 1,392 days. HCV infection was present in 323 (68%). Mortality attributable to AIDS decreased from 4.5 to 1.8 per 100 persons per year. Mortality due to liver failure increased from 0.3 to 0.5 per 100 persons per year ( P<0.01). The survival of patients with and without HCV infection was similar ( P=0.8). Although liver failure is an increasing cause of death among HIV-infected patients receiving HAART, HCV infection has still no impact on the survival of HIV-infected patients.
本研究的目的是调查死亡原因、肝衰竭所致死亡率，以及在广泛使用高效抗逆转录病毒疗法（HAART）前后，肝炎病毒感染对一组HIV感染患者生存情况的影响。丙型肝炎病毒（HCV）相关肝病在感染人类免疫缺陷病毒（HIV）的患者中似乎进展更快。另一方面，在HAART引入之前，HCV对HIV进展的影响存在争议。然而，上一项报告肝衰竭导致死亡率变化的研究发表于1997年，HCV携带对接受HAART的HIV感染患者生存情况的影响仍有待阐明。在这项调查中，研究队列纳入了1989年4月至2000年9月期间接受抗逆转录病毒药物治疗的492名患者。该队列的中位随访时间为1392天。323名（68%）患者存在HCV感染。艾滋病所致死亡率从每年每100人4.5例降至1.8例。肝衰竭所致死亡率从每年每100人0.3例升至0.5例（P<0.01）。有和没有HCV感染患者的生存情况相似（P=0.8）。虽然肝衰竭在接受HAART的HIV感染患者中是一个日益增加的死亡原因，但HCV感染对HIV感染患者的生存情况仍无影响。
