在一项基于人群的艾滋病毒/艾滋病治疗项目中，丙型肝炎病毒合并感染成人对抗逆转录病毒疗法的免疫反应。

Immunologic response to antiretroviral therapy in hepatitis C virus-coinfected adults in a population-based HIV/AIDS treatment program.

作者信息

Braitstein Paula, Zala Carlos, Yip Benita, Brinkhof Martin W G, Moore David, Hogg Robert S, Montaner Julio S G

机构信息

British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada.

出版信息

J Infect Dis. 2006 Jan 15;193(2):259-68. doi: 10.1086/498908. Epub 2005 Dec 7.

DOI:10.1086/498908

PMID:16362890

Abstract

BACKGROUND

We sought to characterize the impact that hepatitis C virus (HCV) infection has on CD4 cells during the first 48 weeks of antiretroviral therapy (ART) in previously ART-naive human immunodeficiency virus (HIV)-infected patients.

METHODS

The HIV/AIDS Drug Treatment Programme at the British Columbia Centre for Excellence in HIV/AIDS distributes all ART in this Canadian province. Eligible individuals were those whose first-ever ART included 2 nucleoside reverse transcriptase inhibitors and either a protease inhibitor or a nonnucleoside reverse transcriptase inhibitor and who had a documented positive result for HCV antibody testing. Outcomes were binary events (time to an increase of > or = 75 CD4 cells/mm3 or an increase of > or = 10% in the percentage of CD4 cells in the total T cell population [CD4 cell fraction]) and continuous repeated measures. Statistical analyses used parametric and nonparametric methods, including multivariate mixed-effects linear regression analysis and Cox proportional hazards analysis.

RESULTS

Of 1186 eligible patients, 606 (51%) were positive and 580 (49%) were negative for HCV antibodies. HCV antibody-positive patients were slower to have an absolute (P<.001) and a fraction (P = .02) CD4 cell event. In adjusted Cox proportional hazards analysis (controlling for age, sex, baseline absolute CD4 cell count, baseline pVL, type of ART initiated, AIDS diagnosis at baseline, adherence to ART regimen, and number of CD4 cell measurements), HCV antibody-positive patients were less likely to have an absolute CD4 cell event (adjusted hazard ratio [AHR], 0.84 [95% confidence interval [CI], 0.72-0.98]) and somewhat less likely to have a CD4 cell fraction event (AHR, 0.89 [95% CI, 0.70-1.14]) than HCV antibody-negative patients. In multivariate mixed-effects linear regression analysis, HCV antibody-negative patients had increases of an average of 75 cells in the absolute CD4 cell count and 4.4% in the CD4 cell fraction, compared with 20 cells and 1.1% in HCV antibody-positive patients, during the first 48 weeks of ART, after adjustment for time-updated pVL, number of CD4 cell measurements, and other factors.

CONCLUSION

HCV antibody-positive HIV-infected patients may have an altered immunologic response to ART.

摘要

背景

我们试图描述在先前未接受过抗逆转录病毒治疗（ART）的人类免疫缺陷病毒（HIV）感染患者接受ART的前48周内，丙型肝炎病毒（HCV）感染对CD4细胞的影响。

方法

不列颠哥伦比亚省卓越艾滋病中心的HIV/AIDS药物治疗项目负责在该加拿大省份分发所有ART。符合条件的个体是那些首次接受ART包括两种核苷类逆转录酶抑制剂以及一种蛋白酶抑制剂或一种非核苷类逆转录酶抑制剂，且HCV抗体检测记录为阳性结果的患者。结局为二元事件（CD4细胞增加≥75个/mm³或总T细胞群体中CD4细胞百分比增加≥10%[CD4细胞分数]的时间）以及连续重复测量。统计分析采用参数和非参数方法，包括多变量混合效应线性回归分析和Cox比例风险分析。

结果

在1186例符合条件的患者中，606例（51%）HCV抗体呈阳性，580例（49%）呈阴性。HCV抗体阳性患者发生绝对CD4细胞事件（P<0.001）和分数CD4细胞事件（P = 0.02）的速度较慢。在调整后的Cox比例风险分析中（控制年龄、性别、基线绝对CD4细胞计数、基线病毒载量、起始ART类型、基线时的艾滋病诊断、对ART方案的依从性以及CD4细胞测量次数），与HCV抗体阴性患者相比，HCV抗体阳性患者发生绝对CD4细胞事件的可能性较小（调整后风险比[AHR]，0.84[95%置信区间[CI]，0.72 - 0.98]），发生CD4细胞分数事件的可能性略小（AHR，0.89[95%CI，0.70 - 1.14]）。在多变量混合效应线性回归分析中，在对随时间更新的病毒载量、CD4细胞测量次数和其他因素进行调整后，在ART的前48周内，HCV抗体阴性患者的绝对CD4细胞计数平均增加75个，CD4细胞分数增加4.4%，而HCV抗体阳性患者分别为20个和1.1%。