Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
J Microbiol Immunol Infect. 2015 Feb;48(1):20-7. doi: 10.1016/j.jmii.2013.08.001. Epub 2013 Sep 21.
The epidemiology and impact of hepatitis δ virus (HDV) on hepatic outcomes and virological and immunological responses to highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV) patients coinfected with hepatitis B virus (HBV) in northern Taiwan have been reported. However, the epidemiology and impact of HDV infection in HIV-HBV coinfection patients in southern Taiwan remains uncertain.
In this cohort study, a total of 64 HIV patients coinfected with HBV were identified between January 1, 2009 and May 30, 2012. The seroprevalence of anti-HDV antibodies, HDV genotyping, clinical manifestations and hepatic outcomes were compared between the patients with and without HDV coinfection, and laboratory examinations and hepatic outcomes were recorded.
Among the 64 HIV patients coinfected with HBV, seven were seropositive for HDV (10.9%). There were no statistically significant differences in risk factors for acquiring HIV infection. During a median observation period of 27.8 months, the adjusted hazard ratio of HDV and HBV genotype (type B vs. non-type B) on hepatitis flare-ups were 62.132 (p = 0.04) and 0.028 (p = 0.01), respectively. All seven patients had genotype II and were HDV viremic. The phylogenetic tree analysis and clinical history evaluation did not identify any clusters of HDV infection.
HDV infection resulted in higher rate of hepatitis flare-ups, but it did not have a statistical significance on HIV progression and immunological response to HAART. Whether higher rate of HDV viremia has worse impact on the hepatic outcomes requires further investigation.
在台湾北部，已有研究报道了乙型肝炎病毒（HBV）与人类免疫缺陷病毒（HIV）共感染患者中δ 型肝炎病毒（HDV）的流行情况及其对肝结局的影响，以及对高效抗逆转录病毒治疗（HAART）的病毒学和免疫学反应。然而，在台湾南部，HBV 与 HIV 共感染患者中 HDV 感染的流行情况和影响仍不确定。
在这项队列研究中，我们于 2009 年 1 月 1 日至 2012 年 5 月 30 日期间共确定了 64 例 HIV 与 HBV 共感染患者。比较了 HDV 共感染与无 HDV 共感染患者的抗-HDV 抗体血清阳性率、HDV 基因分型、临床表现和肝结局，并记录了实验室检查和肝结局。
在 64 例 HIV 与 HBV 共感染患者中，有 7 例抗-HDV 抗体阳性（10.9%）。两组患者在感染 HIV 的危险因素方面无统计学差异。在中位 27.8 个月的观察期间，HDV 和 HBV 基因型（B 型与非 B 型）对肝炎发作的调整后危险比分别为 62.132（p=0.04）和 0.028（p=0.01）。7 例患者均为基因型 II，且均存在 HDV 血症。系统进化树分析和临床病史评估未发现 HDV 感染的聚集性。
HDV 感染导致肝炎发作的发生率更高，但对 HIV 进展和 HAART 的免疫反应无统计学意义。HDV 血症率较高是否对肝结局有更差的影响，尚需进一步研究。
