Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuchang, Wuhan, China.
Infection. 2011 Oct;39(5):427-31. doi: 10.1007/s15010-011-0145-1. Epub 2011 Jun 29.
To investigate the incidence and risk factors of liver-associated morbidity and mortality in Han Chinese patients with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) coinfection.
A retrospective study was conducted.
Of the 255 subjects with HIV and HBV coinfection, 181 (71.0%) received lamivudine-based combined antiretroviral therapy (cART). Of the patients, 49/255 (19.2%) developed advanced liver diseases (ALDs) (during 5.2 years): 30 patients developed clinically overt cirrhosis, 10 developed hepatocellular carcinoma and 9 developed severe reactivation of a preexisting chronic hepatitis B. Baseline CD4(+) cell count <200 cell/mm(3) (P = 0.013, OR = 6.503), baseline alanine aminotransferase (ALT) elevation (P = 0.011, OR = 14.456), and longer cumulated time with detectable HIV RNA (P = 0.008, OR = 1.814) and HBV DNA (P = 0.014, OR = 1.536) were risk factors for ALDs development, while CD4(+) cell count changes ≥150 cells/mm(3) within 3 months (P = 0.039, OR = 0.049) and the use of lamivudine-based cART (P = 0.030, OR = 0.034) were protective against ALDs development.
ALDs was common among HIV and HBV coinfected Han Chinese patients. Lamivudine-based cART was beneficial in terms of sustained HBV viral suppression and resulted in less incidence of ALDs.
研究乙型肝炎病毒（HBV）和人类免疫缺陷病毒（HIV）合并感染的汉族患者肝脏相关发病率和死亡率的发生率及相关危险因素。
本研究采用回顾性研究。
255 例 HIV 和 HBV 合并感染者中，181 例（71.0%）接受了基于拉米夫定的联合抗逆转录病毒治疗（cART）。其中，49 例（19.2%）发生了晚期肝病（ALD）（5.2 年内）：30 例患者发展为明显肝硬化，10 例患者发展为肝细胞癌，9 例患者慢性乙型肝炎原有病情出现严重再激活。基线时 CD4（+）细胞计数＜200 个细胞/mm3（P=0.013，OR=6.503）、基线丙氨酸转氨酶（ALT）升高（P=0.011，OR=14.456）、HIV RNA 可检测时间（P=0.008，OR=1.814）和 HBV DNA 可检测时间（P=0.014，OR=1.536）较长是 ALD 发生的危险因素，而 3 个月内 CD4（+）细胞计数增加≥150 个细胞/mm3（P=0.039，OR=0.049）和使用拉米夫定 cART（P=0.030，OR=0.034）可预防 ALD 的发生。
在汉族 HIV 和 HBV 合并感染患者中，ALD 很常见。基于拉米夫定的 cART 可有效抑制 HBV 病毒复制，ALD 的发生率较低。
