Shores Nathan J, Maida Ivana, Soriano Vincent, Núnez Marina
Division of Gastroenterology, Department of Medicine, Wake Forest University Health System, Winston-Salem, NC, USA.
J Hepatol. 2008 Sep;49(3):323-8. doi: 10.1016/j.jhep.2008.04.010. Epub 2008 May 5.
BACKGROUND/AIMS: There are conflicting data regarding the incidence and factors implicated in the spontaneous clearance of hepatitis C virus (HCV) after acute infection. The aim of this study was to determine the epidemiological factors that predict the resolution of acute HCV infection without therapy in patients with human immunodeficiency virus (HIV) infection.
We conducted a retrospective, multivariate analysis of epidemiological data from HIV-infected patients presenting from 2000 to 2007 with evidence of past or present HCV infection. Data were collected from one American and two European HIV treatment clinics. A final cohort of 769 HIV-infected patients referred for treatment with available test results for antibody to HCV, HCV RNA, and hepatitis B surface antigen were included for the analysis. We calculated spontaneous clearance rates based on race, geographical location, gender, transmission risk factors, and hepatitis B virus coinfection.
Patients who admitted to a history of injection drug use spontaneously cleared the HCV infection significantly less often (11.6%) than those in whom sexual transmission was the presumed route of HCV infection (21.9%) (p=0.004). This difference was more pronounced when heterosexual contact as the source of infection was analyzed separately. Multivariate analysis identified heterosexual HCV transmission (OR 2.81, 95% CI 1.55-5.09) and hepatitis B surface antigen carrier status (OR 10.3, 95% CI 4.29-24.73) as independent factors predicting spontaneous HCV clearance. No differences according to gender, race or geographical origin were observed.
In summary, sexual transmission, particularly heterosexual, and hepatitis B virus coinfection were the only factors associated with spontaneous HCV clearance in this HIV-infected population.
背景/目的：关于急性感染后丙型肝炎病毒（HCV）自发清除的发生率及相关因素，现有数据存在矛盾。本研究旨在确定预测人类免疫缺陷病毒（HIV）感染患者未经治疗的急性HCV感染能否缓解的流行病学因素。
我们对2000年至2007年就诊的有既往或当前HCV感染证据的HIV感染患者的流行病学数据进行了回顾性多变量分析。数据收集自一家美国和两家欧洲的HIV治疗诊所。最终纳入769例接受治疗且有抗HCV、HCV RNA及乙肝表面抗原检测结果的HIV感染患者进行分析。我们根据种族、地理位置、性别、传播风险因素及乙肝病毒合并感染情况计算自发清除率。
有注射吸毒史的患者HCV感染自发清除率（11.6%）显著低于以性传播为推测的HCV感染途径的患者（21.9%）（p = 0.004）。当单独分析以异性接触为感染源时，这种差异更为明显。多变量分析确定异性HCV传播（比值比2.81，95%置信区间1.55 - 5.09）和乙肝表面抗原携带者状态（比值比10.3，95%置信区间4.29 - 24.73）是预测HCV自发清除的独立因素。未观察到性别、种族或地理来源方面的差异。
总之，在这一HIV感染人群中，性传播，尤其是异性传播，以及乙肝病毒合并感染是与HCV自发清除相关的唯一因素。
