University of California San Francisco, San Francisco, California 94143-0538, USA.
AIDS. 2012 Mar 13;26(5):599-607. doi: 10.1097/QAD.0b013e32834fa121.
Co-infection with hepatitis C virus (HCV) is a major cause of morbidity and mortality in HIV-infected individuals. However, predictors of mortality are poorly defined and most studies have focused predominantly on co-infection in men. We evaluated whether two indirect markers of hepatic fibrosis, aspartate aminotransferase-to-platelet ratio index (APRI) and FIB-4 scores, were predictive of mortality in a well defined longitudinal cohort of HCV/HIV-co-infected women on HAART.
HCV/HIV-co-infected women on antiretroviral therapy enrolled in Women's Interagency HIV Study (WIHS), a National Institutes of Health-funded prospective, multicenter, cohort study of women with and at risk for HIV infection were included. Using Cox regression analysis, associations between APRI and FIB-4 with all-cause mortality were assessed.
Four hundred and fifty HCV/HIV-co-infected women, of whom 191 women died, had a median follow-up of 6.6 years and 5739 WIHS visits. Compared with women with low APRI or FIB-4 levels, severe fibrosis was significantly associated with an increased risk of all-cause mortality {APRI: hazard ratio 2.78 [95% confidence interval (CI) 1.87, 4.12]; FIB-4: hazard ratio 2.58 (95% CI 1.68, 3.95)}. Crude death rates per 1000 patient-years increased with increasing liver fibrosis: 34.8 for mild, 51.3 for moderate and 167.9 for severe fibrosis as measured by FIB-4. Importantly, both APRI and FIB-4 increased during the 5 years prior to death for all women: the slope of increase was greater for women dying a liver-related death compared with nonliver-related death.
Both APRI and FIB-4 are independently associated with all-cause mortality in HCV/HIV-co-infected women and may have clinical prognostic utility among women with HIV and HCV.
丙型肝炎病毒（HCV）合并感染是 HIV 感染者发病和死亡的主要原因。然而，对于死亡率的预测因素尚未明确，且大多数研究主要集中在男性合并感染上。我们评估了两种间接肝纤维化标志物，即天门冬氨酸氨基转移酶与血小板比值指数（APRI）和 FIB-4 评分，在接受高效抗逆转录病毒治疗（HAART）的 HCV/HIV 合并感染女性的明确的纵向队列研究中，是否能预测死亡率。
纳入参加妇女艾滋病研究机构（WIHS）的接受抗病毒治疗的 HCV/HIV 合并感染女性，这是一项由美国国立卫生研究院资助的前瞻性、多中心、HIV 感染和有感染风险的女性队列研究。使用 Cox 回归分析，评估 APRI 和 FIB-4 与全因死亡率之间的相关性。
450 例 HCV/HIV 合并感染女性，其中 191 例死亡，中位随访 6.6 年，共进行了 5739 次 WIHS 就诊。与 APRI 或 FIB-4 水平较低的女性相比，严重纤维化与全因死亡率增加显著相关{APRI：风险比 2.78（95%置信区间 1.87，4.12）；FIB-4：风险比 2.58（95%置信区间 1.68，3.95）}。按纤维化程度划分的粗死亡率（每 1000 患者年）随肝纤维化程度的增加而增加：轻度纤维化为 34.8，中度纤维化为 51.3，FIB-4 重度纤维化为 167.9。重要的是，在所有女性死亡前的 5 年内，APRI 和 FIB-4 均增加：与非肝脏相关死亡相比，死于肝脏相关死亡的女性增加幅度更大。
APRI 和 FIB-4 均与 HCV/HIV 合并感染女性的全因死亡率独立相关，在 HIV 和 HCV 合并感染的女性中可能具有临床预后效用。
