Attia Koffi Alain, Eholié Serge, Messou Eugène, Danel Christine, Polneau Sandrine, Chenal Henri, Toni Thomas, Mbamy Myreille, Seyler Catherine, Wakasugi Naomi, N'dri-Yoman Thérèse, Anglaret Xavier
Koffi Alain Attia, Thérèse N'dri-Yoman, Department of General Medicine and Hepato-Gastroenterology, Teaching Hospital of Yopougon, Abidjan 1021, Côte d'Ivoire.
World J Hepatol. 2012 Jul 27;4(7):218-23. doi: 10.4254/wjh.v4.i7.218.
To determine the prevalence of hepatitis B virus (HBV) in adult human immunodeficiency virus (HIV) patients with CD4+ T-cell count less than 500/mm(3) and without antiretroviral therapy; to describe different HBV-HIV coinfection virological profiles; and to search for factors associated with HBs antigen (HBsAg) presence in these HIV positive patients.
During four months (June through September 2006), 491 patients were received in four HIV positive monitoring clinical centers in Abidjan.
HIV-1 or HIV-1 and 2 positive patients, age ≥ 18 years, CD4+ T-cell count < 500/mL and formal and signed consent of the patient. Realized blood tests included HIV serology, CD4+ T-cell count, quantitative HIV RNA load and HBV serological markers, such as HBsAg and HBc antibody (anti-HBcAb). We performed HBeAg, anti-HBe antibody (anti-HBeAb), anti-HBc IgM and quantitative HBV DNA load in HBsAg positive patients. Anti-HBsAb had been tested in HIV patients with HBsAg negative and anti-HBcAb-positive. HBV DNA was also tested in 188 anti-HBcAb positive patients with HBsAg negative status and without anti-HBsAb. Univariate analysis (Pearson χ(2) test or Fischer exact test) and multivariate analysis (backward step-wise selection logistic regression) were performed as statistical analysis.
Mean age of 491 patients was 36 ± 8.68 years and 73.3% were female. Type-1 HIV was found in 97% and dual-type HIV (type 1 plus type 2) in 3%. World Health Organization (WHO) clinical stage was 1, 2, 3 and 4 respectively in 61 (12.4%), 233 (47.5%), 172 (35%) and 25 patients (5.1%). Median CD4+ T-cell count was 341/mm(3) (interquartile range: 221-470). One hundred and twelve patients had less than 200 CD4+ T-cell/mm(3). Plasma HIV-1 RNA load was elevated (≥ 5 log(10) copies/mL) in 221 patients (45%). HBsAg and anti-HBcAb prevalence was respectively 13.4% and 72.9%. Of the 66 HBsAg positive patients, 22 were inactive HBV carriers (33.3%), 21 had HBeAg positive hepatitis (31.8%) and 20 had HBeAg negative hepatitis (30.3%). HBeAg and anti-HBeAb were indeterminate in 3 of them. Occult B infection prevalence (HBsAg negative, anti-HBcAb positive, anti-HBsAb negative and detectable HBV DNA) was 21.3%. Three parameters were significantly associated with the presence of HBsAg: male [odds ratio (OR): 2.2; P = 0.005; 95% confidence interval (CI): 1.3-3.8]; WHO stage 4 (OR: 3.2; P = 0.01; 95% CI: 1.3-7.9); and aspartate aminotransferase (AST) level higher than the standard (OR: 1.9; P = 0.04; 95% CI: 1.02-3.8).
HBV infection prevalence is high in HIV-positive patients. HBeAg positive chronic hepatitis and occult HBV infection are more frequent in HIV-positive patients than in HIV negative ones. Parameters associated with HBsAg positivity were male gender, AIDS status and increased AST level.
确定CD4+T细胞计数低于500/mm³且未接受抗逆转录病毒治疗的成年人类免疫缺陷病毒（HIV）患者中乙型肝炎病毒（HBV）的流行情况；描述不同的HBV-HIV合并感染病毒学特征；并寻找这些HIV阳性患者中与乙肝表面抗原（HBsAg）存在相关的因素。
在2006年6月至9月的四个月期间，阿比让的四个HIV阳性监测临床中心接收了491例患者。
HIV-1或HIV-1和2阳性患者，年龄≥18岁，CD4+T细胞计数<500/mL，且患者签署正式同意书。进行的血液检测包括HIV血清学、CD4+T细胞计数、HIV RNA定量载量以及HBV血清学标志物，如HBsAg和乙肝核心抗体（抗-HBcAb）。我们对HBsAg阳性患者进行了HBeAg、抗-HBe抗体（抗-HBeAb）、抗-HBc IgM和HBV DNA定量检测。对HBsAg阴性且抗-HBcAb阳性的HIV患者检测了抗-HBsAb。还对188例抗-HBcAb阳性、HBsAg阴性且无抗-HBsAb的患者进行了HBV DNA检测。采用单因素分析（Pearson χ²检验或Fisher精确检验）和多因素分析（向后逐步选择逻辑回归）进行统计分析。
491例患者的平均年龄为36±8.68岁，73.3%为女性。97%的患者感染HIV-1，3%为HIV-1和2双重感染。世界卫生组织（WHO）临床分期1、2、3和4期的患者分别有61例（12.4%）、233例（47.5%）、172例（35%）和25例（5.1%）。CD4+T细胞计数中位数为³41/mm³（四分位间距：221-470）。112例患者的CD4+T细胞计数低于200/mm³。221例患者（45%）的血浆HIV-1 RNA载量升高（≥5 log₁₀拷贝/mL）。HBsAg和抗-HBcAb的流行率分别为13.4%和72.9%。在66例HBsAg阳性患者中，22例为非活动性HBV携带者（33.3%），21例为HBeAg阳性肝炎（31.8%），20例为HBeAg阴性肝炎（30.3%）。其中3例患者的HBeAg和抗-HBeAb结果不确定。隐匿性乙肝感染流行率（HBsAg阴性、抗-HBcAb阳性、抗-HBsAb阴性且可检测到HBV DNA）为21.3%。有三个参数与HBsAg的存在显著相关：男性[比值比（OR）：2.2；P=0.005；95%置信区间（CI）：1.3-3.8]；WHO 4期（OR：3.2；P=0.01；95%CI：1.3-7.9）；以及天冬氨酸转氨酶（AST）水平高于标准值（OR：1.9；P=0.04；95%CI：1.02-3.8）。
HIV阳性患者中HBV感染流行率较高。HIV阳性患者中HBeAg阳性慢性肝炎和隐匿性HBV感染比HIV阴性患者更常见。与HBsAg阳性相关的参数为男性、艾滋病状态和AST水平升高。
