在过去 20 年中，美国一组 HIV 感染个体中乙型肝炎病毒感染的流行病学。
Epidemiology of Hepatitis B virus infection in a US cohort of HIV-infected individuals during the past 20 years.
机构信息
Naval Health Research Center and Naval Medical Center San Diego, San Diego, California, USA.
出版信息
Clin Infect Dis. 2010 Feb 1;50(3):426-36. doi: 10.1086/649885.
BACKGROUND
The epidemiologic trends of hepatitis B virus (HBV) infection in human immunodeficiency virus (HIV)-infected patients over the past 20 years are largely unknown.
METHODS
Prevalence and risk factors for HBV infection overall, at the time of HIV infection, and after HIV infection were examined in an ongoing observational HIV cohort study. Risk factors for HBV infection at the time of diagnosis of HIV infection were evaluated using logistic regression, and risk of incident HBV infection after diagnosis of HIV infection was evaluated using Cox proportional hazards models.
RESULTS
Of the 2769 evaluable participants, 1078 (39%) had HBV infection, of whom 117 (11%) had chronic HBV infection. The yearly cross-sectional prevalence of HBV infection decreased from a peak of 49% in 1995 to 36% in 2008 (P < .001). The prevalence of HBV infection at the time of diagnosis of HIV infection decreased during 1989-2008 from 34% to 9% (P < .001). The incidence of HBV infection after diagnosis of HIV infection decreased from 4.0 cases per 100 person-years during the pre-highly active antiretroviral therapy (HAART) era to 1.1 cases per 100 person-years during the HAART era (P < .001); however, this incidence remained unchanged during 2000-2008 (P = .49), with >20% of HBV infections occurring after HIV infection being chronic. Decreased risk of HBV infection after diagnosis of HIV infection was associated with higher CD4 cell count and the use of HBV-active HAART. Receipt of 1 dose of HBV vaccine was not associated with reduced risk of HBV infection after diagnosis of HIV infection.
CONCLUSIONS
Although the burden of HBV infection overall is slowly decreasing among HIV-infected individuals, the persistent rate of HBV infection after diagnosis of HIV infection raises concern that more-effective prevention strategies may be needed to significantly reduce the prevalence of HBV infection in this patient population.
背景
在过去的 20 年中，人类免疫缺陷病毒（HIV）感染者中乙型肝炎病毒（HBV）感染的流行病学趋势在很大程度上尚不清楚。
方法
在一项正在进行的观察性 HIV 队列研究中，检查了总体上、感染 HIV 时以及感染 HIV 后的 HBV 感染的流行率和危险因素。使用逻辑回归评估 HIV 感染诊断时 HBV 感染的危险因素，并使用 Cox 比例风险模型评估 HIV 感染诊断后发生 HBV 感染的风险。
结果
在 2769 名可评估的参与者中，有 1078 名（39％）患有 HBV 感染，其中 117 名（11％）患有慢性 HBV 感染。HBV 感染的年度横断面流行率从 1995 年的高峰 49％下降到 2008 年的 36％（P <.001）。1989 年至 2008 年，HIV 感染诊断时 HBV 感染的流行率从 34％下降到 9％（P <.001）。HIV 感染诊断后 HBV 感染的发生率从抗逆转录病毒治疗（HAART）前的每 100 人年 4.0 例下降到 HAART 时代的每 100 人年 1.1 例（P <.001）；然而，2000 年至 2008 年期间这一发生率没有变化（P =.49），超过 20％的 HBV 感染发生在 HIV 感染之后，是慢性的。HIV 感染诊断后 HBV 感染风险降低与 CD4 细胞计数较高和使用 HBV 活性的 HAART 有关。接受 1 剂 HBV 疫苗接种与 HIV 感染诊断后 HBV 感染风险降低无关。
结论
尽管 HIV 感染者中 HBV 感染的总体负担正在缓慢下降，但 HIV 感染诊断后 HBV 感染的持续发生率令人担忧，可能需要更有效的预防策略来显著降低该患者人群中 HBV 感染的流行率。
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