Department of Medicine I, University of Bonn, Germany.
J Hepatol. 2013 Aug;59(2):213-20. doi: 10.1016/j.jhep.2013.04.005. Epub 2013 Apr 11.
BACKGROUND & AIMS: The influence of HCV-RNA levels and genotype on HCV disease progression is not well studied. The prognostic value of these markers was investigated in HIV/HCV co-infected individuals from the EuroSIDA cohort.
EuroSIDA is a prospective cohort of 18,295 HIV-1 infected patients in 105 centres across Europe, Israel, and Argentina. All subjects with known HCV antibody (HCVAb) status (n=13,025) were enrolled in the present study.
4044 (31.0%) patients had detectable HCVAb. After adjustment, HCVAb+ patients had an increased incidence of liver-related death (LRD) compared to HCVAb- individuals (IRR 8.90; 95% CI 5.60-14.14, p<0.0001). Information on HCV-RNA was available for 2709 (67.0%) HCVAb+ patients and 2010 (74.2%) were HCV-RNA+. Of 1907 patients with measured HCV genotype, 1008 (52.9%), 62 (3.3%), 567 (29.7%), and 270 (14.2%) were infected with genotype 1, 2, 3 and 4, respectively. Patients with detectable HCV-RNA had similar incidence of non-LRD, but higher incidence of LRD compared to HCVAb+ aviremic patients (adjusted IRR 1.18; 95% CI 0.93-1.50, p=0.17) and (adjusted IRR 2.11; 95% CI 1.30-3.42, p=0.0025), respectively. In patients with HCV viremia, HCV-RNA levels and HCV genotype did not influence the risk of non-LRD or LRD.
HCV seropositive HIV patients had a 9-fold increased risk of LRD compared to patients who were HCV seronegative. Risk of death from any cause or LRD was not influenced by level of HCV viremia or HCV genotype.
HCV-RNA 水平和基因型对 HCV 疾病进展的影响尚未得到充分研究。本研究旨在探讨这些标志物在来自 EuroSIDA 队列的 HIV/HCV 合并感染人群中的预后价值。
EuroSIDA 是一项在欧洲、以色列和阿根廷的 105 个中心进行的前瞻性 HIV-1 感染患者队列研究。所有已知 HCV 抗体（HCVAb）状态的受试者（n=13025）均纳入本研究。
4044（31.0%）例患者检测到 HCVAb。调整后，HCVAb+患者的肝相关死亡率（LRD）较 HCVAb-个体增加（IRR 8.90；95%CI 5.60-14.14，p<0.0001）。2709 例 HCVAb+患者中有 2709 例（67.0%）有 HCV-RNA 信息，2010 例（74.2%）为 HCV-RNA+。在 1907 例有测量 HCV 基因型的患者中，1008 例（52.9%）、62 例（3.3%）、567 例（29.7%）和 270 例（14.2%）分别感染了基因型 1、2、3 和 4。有可检测到的 HCV-RNA 的患者非 LRD 发生率相似，但 LRD 发生率高于 HCVAb+无病毒血症患者（调整后的 IRR 1.18；95%CI 0.93-1.50，p=0.17）和（调整后的 IRR 2.11；95%CI 1.30-3.42，p=0.0025）。在 HCV 病毒血症患者中，HCV-RNA 水平和 HCV 基因型不影响非 LRD 或 LRD 的风险。
与 HCV 血清阴性的患者相比，HCV 血清阳性的 HIV 患者 LRD 的风险增加了 9 倍。HCV 病毒血症或 HCV 基因型水平对任何原因导致的死亡率或 LRD 风险无影响。
