尼日利亚乔斯市艾滋病毒/艾滋病与肝炎病毒合并感染患者免疫和病毒学转归的前瞻性队列研究。

A prospective cohort study of immunologic and virologic outcomes in patients with HIV/AIDS and hepatitis virus co-infection in Jos, Nigeria.

作者信息

lsa S E, Gwamzhi L N, Akolo C, Giyan J

机构信息

Federal Medical Center, Keffi, Nigeria. ejijisa@yahoo

出版信息

Niger J Med. 2010 Jul-Sep;19(3):279-85. doi: 10.4314/njm.v19i3.60188.

DOI:10.4314/njm.v19i3.60188

PMID:20845631

Abstract

BACKGROUND

In this era of highly active antiretroviral therapy (HAART), hepatitis B and C virus (HBV and HCV) co-infection have emerged as significant co-morbid conditions. Local reports indicate that co-infection is not uncommon in Nigeria as in other sub-Saharan African countries. Whether treatment outcomes of HIV mono-infected patients differ from those with co-infection remains largely unknown. We hypothesised that co-infected patients will have lower CD4+ count recovery and viralload reduction following HAART.

METHODS

A cohort study in antiretroviral therapy-naïve HIV-infected adults involving 150 cases (HIV and co-infection) and 150 controls (HIV infection only). Patients' care was according to the National guidelines and patients received first line therapy mostly comprising Lamivudine, Stavudine and Nevirapine. Medication adherence was monitored using pharmacy computerised system, and CD4+ cell counts and HIV viral load (VL) were compared at baseline, 3 and 6 months of therapy

RESULTS

There were 98 (65.3%) and 96 (64%) female cases and controls (p = 0.79) respectively. The mean ages of cases and controls were 38 +/- 8.4 and 37 +/- 8.9 years (p = 0.20) respectively. Cases comprised 73 (48%) HBV, 70 (47%) HCV and 7 (5%) with both HBV and HCV infection. Medication adherence was > 95% in both arms. Attrition rate was 2.7% (8); seven of them were co-infected. Five cases (3.3%) compared to zero controls developed clinical hepatitis. The proportions of patients with CD4+ count < 200 cells/microl among cases and controls were 111 (74%) and 109 (72%), p = 0.36 at baseline; 66 (45.5%) and 64 (42.7%), p = 0.21 at 3 months; 60 (42%) and 56 (37.6%), p = 0.40 at 6 months respectively. Significantly more controls (60.7%) had CD4+ increases 50 cells/microl at 3 months compared to 37 (54.5%) HCV+ cases (p = 0.03). No significant difference in CD4+ counts between controls and cases at 6 months. The baseline median VL for cases and controls were log(10)4.95 and log(10)4.83 (p = 0.17) respectively. The proportions of cases and controls with undetectable VL at 3 and 6 months were 96 (66.2%) and 97 (65.5%); p = 0.74, and 116 (81.1%) and 97 (79.3%); p = 0.010 respectively.

CONCLUSION

Co-infection has limited impact on immunologic and virologic outcomes, but may be an important cause of hepatotoxicity.

摘要

背景

在高效抗逆转录病毒治疗（HAART）时代，乙型和丙型肝炎病毒（HBV和HCV）合并感染已成为重要的共病情况。当地报告表明，与其他撒哈拉以南非洲国家一样，合并感染在尼日利亚并不罕见。HIV单感染患者与合并感染患者的治疗结果是否不同在很大程度上仍不清楚。我们假设合并感染患者在接受HAART后CD4 +细胞计数恢复和病毒载量降低的幅度较小。

方法

一项针对未接受过抗逆转录病毒治疗的HIV感染成人的队列研究，包括150例病例（HIV感染及合并感染）和150例对照（仅HIV感染）。患者的治疗遵循国家指南，患者接受的一线治疗主要包括拉米夫定、司他夫定和奈韦拉平。使用药房计算机系统监测药物依从性，并在治疗的基线、3个月和6个月时比较CD4 +细胞计数和HIV病毒载量（VL）。

结果

病例组和对照组分别有98例（65.3%）和96例（64%）女性（p = 0.79）。病例组和对照组的平均年龄分别为38±8.4岁和37±8.9岁（p = 0.20）。病例组包括73例（48%）HBV感染、70例（47%）HCV感染和7例（5%）HBV和HCV合并感染。两组的药物依从性均> 95%。失访率为2.7%（8例）；其中7例为合并感染。5例病例（3.3%）出现临床肝炎，而对照组为零。病例组和对照组中CD4 +细胞计数<200个/微升的患者比例在基线时分别为111例（74%）和109例（72%），p = 0.36；3个月时分别为66例（45.5%）和64例（42.7%），p = 0.21；6个月时分别为60例（42%）和56例（37.6%）', p = 0.40。与37例（54.5%）HCV合并感染病例相比，显著更多的对照组（60.7%）在3个月时CD4 +细胞计数增加了50个/微升（p = 0.03）。6个月时对照组和病例组的CD4 +细胞计数无显著差异。病例组和对照组的基线中位病毒载量分别为log(10)4.95和log(10)4.83（p = 0.17）。3个月和6个月时病毒载量不可检测的病例组和对照组比例分别为96例（66.2%）和97例（65.5%）；p = 0.74，以及116例（81.1%）和97例（79.3%）；p = 0.010。