HIV、年龄与丙型肝炎病毒相关肝病严重程度：一项队列研究。
HIV, age, and the severity of hepatitis C virus-related liver disease: a cohort study.
机构信息
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
出版信息
Ann Intern Med. 2013 May 7;158(9):658-66. doi: 10.7326/0003-4819-158-9-201305070-00604.
BACKGROUND
Persons with HIV infection have been reported to develop age-related diseases at younger ages than those without HIV. Whether this finding is related to HIV infection or failure to control for other risk factors is unknown.
OBJECTIVE
To investigate whether persons with HIV infection develop hepatitis C virus (HCV)-related liver disease at younger ages than similar persons without HIV.
DESIGN
Comparison of the severity of liver fibrosis by age among persons who have HCV with and without HIV followed concurrently in the same protocol.
SETTING
Observational cohort from Baltimore, Maryland, participating in the ALIVE (AIDS Linked to the IntraVenous Experience) study.
PARTICIPANTS
1176 current and former injection drug users with antibodies to HCV.
MEASUREMENTS
Liver fibrosis assessed semiannually from 2006 to 2011 by elastography (FibroScan, Echosens, Paris, France) and using previously validated thresholds for clinically significant fibrosis and cirrhosis; concurrent assessment of medical history, alcohol and illicit drug use, HCV RNA levels, hepatitis B virus surface antigen level, body mass index, and (for those with HIV) CD4+ lymphocyte count and HIV RNA levels.
RESULTS
Among 1176 participants with antibodies to HCV, the median age was 49 years and 34% were coinfected with HIV and HCV. Participants contributed 5634 valid liver fibrosis measurements. The prevalence of clinically significant fibrosis without cirrhosis (12.9% vs. 9.5%) and of cirrhosis (19.5% vs. 11.0%) was greater in persons coinfected with HIV and HCV than in those with only HCV (P < 0.001). Increasing age and HIV infection were independently associated with liver fibrosis, as were daily alcohol use, chronic hepatitis B virus infection, body mass index greater than 25 kg/m2, and greater plasma HCV RNA levels. When these factors were kept constant, persons with HIV had liver fibrosis measurements equal to those of persons without HIV, who were, on average, 9.2 years older.
LIMITATION
The process of liver fibrosis began before the study in most persons.
CONCLUSION
In this cohort, persons who have HCV with HIV have liver fibrosis stages similar to those without HIV who are nearly a decade older.
PRIMARY FUNDING SOURCE
National Institute on Drug Abuse.
背景
据报道，HIV 感染者比未感染 HIV 的人更早地出现与年龄相关的疾病。尚不清楚这种发现是与 HIV 感染有关，还是与未能控制其他危险因素有关。
目的
研究 HIV 感染者是否比未感染 HIV 的相似人群更早地发生丙型肝炎病毒（HCV）相关的肝病。
设计
在相同方案中同时随访患有 HCV 且具有和不具有 HIV 的个体，比较他们的肝纤维化严重程度与年龄的关系。
地点
马里兰州巴尔的摩的观察性队列，参与 ALIVE（AIDS 与静脉内经验相关）研究。
参与者
1176 名当前和既往的 HCV 抗体阳性的静脉注射药物使用者。
测量方法
2006 年至 2011 年期间，通过弹性成像（FibroScan，Echosens，法国巴黎）半年度评估肝纤维化，以及使用先前验证的用于临床显著纤维化和肝硬化的阈值；同时评估病史、酒精和非法药物使用、HCV RNA 水平、乙型肝炎病毒表面抗原水平、体重指数以及（对于 HIV 感染者）CD4+淋巴细胞计数和 HIV RNA 水平。
结果
在 1176 名 HCV 抗体阳性的参与者中，中位年龄为 49 岁，34%合并感染 HIV 和 HCV。参与者共提供了 5634 次有效的肝纤维化测量值。与仅感染 HCV 的参与者相比，合并感染 HIV 和 HCV 的参与者中，具有临床显著纤维化但无肝硬化（12.9%比 9.5%）和肝硬化（19.5%比 11.0%）的患病率更高（P<0.001）。年龄增长和 HIV 感染与肝纤维化独立相关，与每日饮酒、慢性乙型肝炎病毒感染、体重指数大于 25kg/m2 和更高的血浆 HCV RNA 水平也相关。当保持这些因素不变时，HIV 感染者的肝纤维化测量值与 HIV 阴性者相等，而 HIV 阴性者的年龄平均大 9.2 岁。
局限性
在大多数人开始研究之前，肝纤维化的过程已经开始。
结论
在本队列中，HIV 合并 HCV 感染者的肝纤维化分期与 HIV 阴性者相似，但后者的年龄大近 10 岁。
主要资金来源
国家药物滥用研究所。
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