HIV-1合并感染对丙型肝炎患者长期死亡率的影响：一项基于人群的队列研究。

The impact of HIV-1 co-infection on long-term mortality in patients with hepatitis C: a population-based cohort study.

作者信息

Omland L H, Jepsen P, Skinhøj P, Jørgensen H L, Münster A-M B, Bangsborg J, Fenger M, Sørensen H T, Obel N

机构信息

Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.

出版信息

HIV Med. 2009 Feb;10(2):65-71. doi: 10.1111/j.1468-1293.2008.00652.x. Epub 2008 Nov 10.

DOI:10.1111/j.1468-1293.2008.00652.x

PMID:19018878

Abstract

OBJECTIVE

To investigate the impact of HIV co-infection on mortality in patients infected with hepatitis C virus (HCV).

METHODS

From a nationwide Danish database of HCV-infected patients, we identified individuals diagnosed with HCV subsequent to an HIV diagnosis. For each co-infected patient, four control HCV patients without HIV were matched on age, gender and year of HCV diagnosis. Data on comorbidity, drug abuse, alcoholism and date of death were extracted from two healthcare databases. We constructed Kaplan-Meier curves and used Cox regression analyses to estimate mortality rate ratios (MRRs), controlling for comorbidity.

RESULTS

We identified 483 HCV-HIV co-infected and 1932 HCV mono-infected patients, yielding 2192 and 9894 person-years of observation with 129 and 271 deaths, respectively. The 5-year probability of survival was 0.74 [95% confidence interval (CI) 0.69-0.80] for HCV-HIV co-infected patients and 0.87 (95% CI 0.85-0.89) for HCV mono-infected patients. Co-infection was associated with substantially increased mortality (MRR 2.1, 95% CI 1.7-2.6). However, prior to the first observed decrease in CD4 counts to below 300 cells/muL, HIV infection did not increase mortality in HCV-infected patients (MRR 0.9, 95% CI 0.5-1.50).

CONCLUSIONS

HIV infection has a substantial impact on mortality among HCV-infected individuals, mainly because of HIV-induced immunodeficiency.

摘要

目的

探讨合并感染人类免疫缺陷病毒（HIV）对丙型肝炎病毒（HCV）感染患者死亡率的影响。

方法

从丹麦全国性的HCV感染患者数据库中，我们识别出在HIV诊断之后被诊断为HCV的个体。对于每一位合并感染的患者，匹配四位年龄、性别和HCV诊断年份相同但未感染HIV的HCV对照患者。从两个医疗保健数据库中提取合并症、药物滥用、酗酒和死亡日期的数据。我们构建了Kaplan-Meier曲线，并使用Cox回归分析来估计死亡率比（MRR），同时控制合并症因素。

结果

我们识别出483例HCV-HIV合并感染患者和1932例HCV单感染患者，分别有2192和9894人年的观察期，死亡人数分别为129例和271例。HCV-HIV合并感染患者的5年生存概率为0.74[95%置信区间（CI）0.69-0.80]，HCV单感染患者为0.87（95%CI 0.85-0.89）。合并感染与死亡率大幅增加相关（MRR 2.1，95%CI 1.7-2.6）。然而，在首次观察到CD4细胞计数降至低于300个/μL之前，HIV感染并未增加HCV感染患者的死亡率（MRR 0.9，95%CI 0.5-1.50）。