Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
J Infect. 2010 Jul;61(2):155-63. doi: 10.1016/j.jinf.2010.04.009. Epub 2010 May 12.
Few studies have investigated the impact of chronic hepatitis B and C infection on antiretroviral therapy (ART) outcomes in sub-Saharan Africa. Hepatotoxicity may be a particular concern in co-infected patients taking nevirapine-stavudine-lamivudine.
We conducted a prospective cohort study of 300 Malawian adults starting ART and describe one-year ART outcomes according to viral hepatitis status.
At baseline, patients had advanced HIV disease (29.3% were in WHO stage 4; mean CD4 = 157 cells/microL; mean log(10)HIV-1 RNA = 5.24 copies/ml). Co-infection with hepatitis B, C and B + C were present in 6.7%, 5.7% and 1.7% respectively. At 50 weeks, all-cause mortality was 43 (14.3%). Sixteen (5.3%) had transferred to another unit. Eight (2.7%) were lost to follow up. Sixteen (5.3%) had stopped ART. 217 (72.3%) were alive on ART, of whom 82.5% had an HIV-1 RNA <400 copies/ml at week 50. During the first 50 weeks of ART, severe hepatotoxicity (liver enzyme values >5 times upper level of normal) occurred in 9%, but did not result in any ART discontinuations. Clinical hepatitis or jaundice was not observed. There were no significant differences in occurrence of hepatotoxicity, other side effects, mortality, severe morbidity, immune reconstitution or virological failure between hepatitis B and/or C co-infected patients and those who were not. Viral hepatitis co-infection was not associated with severe hepatotoxicity, mortality, severe morbidity or virological failure in multivariate analyses.
Our data suggest that screening for viral hepatitis B and C and liver enzyme monitoring may not require high priority in ART programmes in sub-Saharan Africa.
在撒哈拉以南非洲地区，鲜有研究调查慢性乙型肝炎和丙型肝炎感染对艾滋病病毒（HIV）逆转录病毒治疗（ART）结局的影响。对于接受奈韦拉平-司他夫定-拉米夫定治疗的合并感染者，药物性肝毒性可能是一个特殊的关注点。
我们开展了一项前瞻性队列研究，纳入了 300 名开始接受 ART 的马拉维成年人，并根据病毒性肝炎感染状况描述了 1 年的 ART 结局。
基线时，患者的 HIV 疾病已处于晚期（29.3%为世界卫生组织（WHO）第 4 期；平均 CD4 细胞计数为 157 个/μL；平均对数 HIV-1 RNA 为 5.24 拷贝/ml）。乙型肝炎、丙型肝炎和乙型肝炎合并丙型肝炎的合并感染率分别为 6.7%、5.7%和 1.7%。50 周时，全因死亡率为 43（14.3%）。16 例（5.3%）患者转至其他单位。8 例（2.7%）失访。16 例（5.3%）停止了 ART。217 例（72.3%）仍在接受 ART，其中 82.5%在第 50 周时 HIV-1 RNA<400 拷贝/ml。在接受 ART 的前 50 周内，有 9%的患者发生了严重的肝毒性（肝酶值高于正常值上限的 5 倍），但没有导致任何患者停止 ART。未观察到临床肝炎或黄疸。乙型肝炎和/或丙型肝炎合并感染患者与未合并感染患者在肝毒性、其他不良反应、死亡率、严重发病率、免疫重建或病毒学失败的发生率方面无显著差异。多变量分析显示，病毒性肝炎合并感染与严重肝毒性、死亡率、严重发病率或病毒学失败无关。
我们的数据表明，在撒哈拉以南非洲地区的 ART 项目中，筛查乙型肝炎和丙型肝炎以及监测肝酶可能不需要高度优先考虑。
