对感染HIV和未感染HIV的女性中单纯乙肝核心抗体的长期血清学随访
Long-term serologic follow-up of isolated hepatitis B core antibody in HIV-infected and HIV-uninfected women.
作者信息
French Audrey L, Lin Michael Y, Evans Charlesnika T, Benning Lorie, Glesby Marshall J, Young Mary A, Operskalski Eva A, Augenbraun Michael, Peters Marion
机构信息
CORE Center/ Stroger Hospital of Cook County, Northwestern University, Chicago, Illinois 60612, USA.
出版信息
Clin Infect Dis. 2009 Jul 1;49(1):148-54. doi: 10.1086/599610.
BACKGROUND
Isolated antibody to hepatitis B core antigen (anti-HBc) is a common serologic finding in persons infected with human immunodeficiency virus (HIV), but the outcome and clinical significance are uncertain.
METHODS
We performed repeated hepatitis B virus (HBV) serologic tests on women who participated in the Women's Interagency HIV Study and who had isolated anti-HBc at study entry.
RESULTS
Repeated serologic tests were performed for 322 women (282 HIV-infected and 40 HIV-uninfected) at a median of 7.5 years after study entry. Seventy-one percent of women retained isolated anti-HBc serologic status, 20% acquired antibody to hepatitis B surface antigen (anti-HBs), and 2% acquired hepatitis B surface antigen (HBsAg). In unadjusted analysis, increasing age, injection drug use, and hepatitis C viremia were negatively associated with acquisition of anti-HBs. For HIV-infected women, predictors of acquisition of anti-HBs were an increase in CD4 cell count and the use of highly active antiretroviral therapy (HAART). Receipt of drugs with activity against HBV and self-reported HBV vaccination did not predict anti-HBs acquisition. In the multivariable regression model, HAART use remained a significant predictor of anti-HBs acquisition, whereas women with hepatitis C viremia were more likely to retain isolated anti-HBc serologic status.
CONCLUSIONS
Isolated anti-HBc status remained stable over time for the majority of women, especially women with chronic hepatitis C virus infection. Development of anti-HBs was predicted by HAART use and an increase in CD4 cell count. We conclude that a proportion of HIV-infected women with isolated anti-HBc have prior natural HBV infection with anti-HBs that is at an undetectable level because of immune dysfunction. Isolated anti-HBc in the presence of chronic hepatitis C virus infection may be attributable to a different phenomenon, such as dysfunctional antibody production.
背景
乙肝核心抗原单独抗体（抗-HBc）是感染人类免疫缺陷病毒（HIV）者常见的血清学表现，但结果及临床意义尚不确定。
方法
我们对参与女性机构间HIV研究且在研究入组时存在单独抗-HBc的女性进行了重复的乙肝病毒（HBV）血清学检测。
结果
在研究入组后中位7.5年时，对322名女性（282名HIV感染者和40名未感染HIV者）进行了重复血清学检测。71%的女性维持单独抗-HBc血清学状态，20%获得乙肝表面抗原抗体（抗-HBs），2%获得乙肝表面抗原（HBsAg）。在未校正分析中，年龄增加、注射吸毒和丙型肝炎病毒血症与抗-HBs的获得呈负相关。对于HIV感染女性，抗-HBs获得的预测因素是CD4细胞计数增加和使用高效抗逆转录病毒治疗（HAART）。接受具有抗HBV活性的药物及自我报告的HBV疫苗接种并不能预测抗-HBs的获得。在多变量回归模型中，使用HAART仍然是抗-HBs获得的显著预测因素，而丙型肝炎病毒血症女性更有可能维持单独抗-HBc血清学状态。
结论
大多数女性，尤其是慢性丙型肝炎病毒感染女性，单独抗-HBc状态随时间保持稳定。HAART使用和CD4细胞计数增加可预测抗-HBs的出现。我们得出结论，一部分单独抗-HBc的HIV感染女性既往有自然HBV感染并产生了抗-HBs，但由于免疫功能障碍而处于不可检测水平。慢性丙型肝炎病毒感染情况下的单独抗-HBc可能归因于不同现象，如抗体产生功能障碍。
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