Gebo Kelly A, Diener-West Marie, Moore Richard D
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
J Acquir Immune Defic Syndr. 2003 Oct 1;34(2):165-73. doi: 10.1097/00126334-200310010-00006.
To determine whether hepatitis C virus (HCV) infection status affected hospitalization rates, intensive care utilization rates, and discharge diagnoses between 1995 and 2000 in patients with HIV.
We conducted a prospective cohort study of 3730 HIV patients who were longitudinally followed between 1995 and 2000. All hospitalizations of these patients were classified as an opportunistic illness (OI) using the 1993 indicator diagnoses in the case definition of AIDS, complication of injection drug use (IDU) (abscess, cellulitis, osteomyelitis, bacteremia, endocarditis, and poisoning by analgesics), liver-related complication (acute and subacute necrosis of the liver, chronic liver disease and cirrhosis, liver abscess, hepatic coma, portal hypertension, hepatorenal syndrome, hepatocellular carcinoma, and gastrointestinal bleed), or other. Negative binomial regression was used to assess for risk factors for hospitalization.
Inpatient hospitalization and intensive care utilization rates and discharge diagnoses.
Nearly half (42.8%) of our cohort was infected with HCV. Between 1995 and 2000, hospitalization rates for HCV-negative patients decreased from 61.9 to 33.9 per 100 patient-years (PY) of follow-up (P = 0.007). Hospitalization rates decreased between 1995 and 1997 for HCV-positive patients from 55.4 to 43.5 per 100 PY but increased between 1997 and 2000 from 43.5 to 62.9 per 100 PY (P = 0.001). When stratified by diagnostic category, IDU-related complications increased from 13.6 to 18.4 admissions per 100 PY and liver-related complications increased from 5.4 to 26.7 admissions per 100 PY between 1995 and 2000 in HCV-positive patients (P < 0.001); however, OIs remained relatively unchanged from 1995 to 2000, with 14.6 to 13.0 hospitalizations per 100 PY. In multivariate analysis, HCV infection (incidence rate ratio [IRR] = 1.75, 95% confidence interval [CI]: 1.47, 2.07), female gender (IRR = 1.56, 95% CI: 1.32, 1.85), age <37 years (IRR = 1.19, 95% CI: 1.01, 1.41), African American ethnicity (IRR = 1.30, 95% CI: 1.05, 1.61), and CD4 cell count <50 cells mm3 (IRR = 2.20, 95% CI: 1.72, 2.83) were predictive of hospitalization.
Our data indicate that hospitalization rates decreased significantly between 1995 and 2000 for HCV-negative patients but increased significantly for HCV-positive patients. Hospitalization rates for IDU- and liver-related complications increased during this time interval in coinfected patients. In the era of highly active antiretroviral therapy, HIV/HCV-coinfected patients are more likely to suffer from higher hospitalization rates, which will require more health care resources.
确定1995年至2000年间丙型肝炎病毒（HCV）感染状况是否影响HIV患者的住院率、重症监护利用率及出院诊断。
我们对3730例HIV患者进行了一项前瞻性队列研究，于1995年至2000年间对其进行纵向随访。根据1993年艾滋病病例定义中的指标诊断，将这些患者的所有住院情况分为机会性感染（OI）、注射吸毒（IDU）并发症（脓肿、蜂窝织炎、骨髓炎、菌血症、心内膜炎及镇痛药中毒）、肝脏相关并发症（急性和亚急性肝坏死、慢性肝病和肝硬化、肝脓肿、肝昏迷、门静脉高压、肝肾综合征、肝细胞癌及胃肠道出血）或其他。采用负二项回归评估住院的危险因素。
住院率、重症监护利用率及出院诊断。
近一半（42.8%）的队列患者感染了HCV。1995年至2000年间，HCV阴性患者的住院率从每100患者年（PY）随访61.9次降至33.9次（P = 0.007）。HCV阳性患者的住院率在1995年至1997年间从每100 PY的55.4次降至43.5次，但在1997年至2000年间从每100 PY的43.5次增至62.9次（P = 0.001）。按诊断类别分层时，1995年至2000年间，HCV阳性患者中与IDU相关的并发症从每100 PY的13.6例入院增加至18.4例，与肝脏相关的并发症从每100 PY的5.4例入院增加至26.7例（P < 0.001）；然而，1995年至2000年间OI相对保持不变，每100 PY有14.6至13.0次住院。多变量分析中，HCV感染（发病率比[IRR] = 1.75，95%置信区间[CI]：1.47，2.07）、女性（IRR = 1.56，95% CI：
