Ladep Nimzing G, Agbaji Oche O, Agaba Patricia A, Muazu Auwal, Ugoagwu Placid, Imade Godwin, Cooke Graham S, Vivas Livia, Cormack Sheena Mc, Taylor-Robinson Simon D, Idoko John, Kanki Phyllis
Hepatology Unit, Department of Medicine, Imperial College London, St Mary's Hospital Campus, South Wharf Road, London W2 1NY, United Kingdom.
AIDS Prevention Initiative in Nigeria & Jos University Teaching Hospital, 2 Murtala Mohammed Way, PMB 2076, Jos, Plateau State, Nigeria.
J AIDS Clin Res. 2013 Jun 29;Suppl 3. doi: 10.4172/2155-6113.S3-006.
Hepatitis B has been reported to be high in HIV-infected African populations. However, the impact of this co-infection on the survival of HIV-infected Africans on long-term highly active antiretroviral therapy (HAART) remains poorly characterised. We investigated the impact of HBV/HIV co-infection on survival of HIV infected patients undergoing antiretroviral therapy in a West African population.
This was a clinic-based cohort study of HIV-infected adults enrolled in Nigeria, West Africa. Study subjects (9,758) were screened for hepatitis B and hepatitis C at HAART initiation. Kaplan-Meier survival and Cox proportional hazards models were used to estimate probability of survival and to identify predictors of mortality respectively, based on hepatitis B surface antigen status. All patients had signed an informed written consent before enrolment into the study; and we additionally obtained permission for secondary use of data from the Harvard institutional review board.
Patients were followed up for a median of 41 months (interquartile range: 30-62 months) during which, 181 (1.9%) patients died. Most of the deaths; 143 (79.0%) occurred prior to availability of Tenofovir. Among those that were on antiretroviral therapy, hepatitis B co-infected patients experienced a significantly lower survival than HIV mono-infected patients at 74 months of follow up (94% vs. 97%; p=0.0097). Generally, hepatitis B co-infection: HBsAg-positive/HIV-positive (Hazards Rate [HR]; 1.5: 95% CI 1.09-2.11), co-morbid tuberculosis (HR; 2.2: 95% CI 1.57-2.96) and male gender (HR; 1.5: 95% CI 1.08-2.00) were significantly predictive of mortality. Categorising the patients based on use of Tenofovir, HBV infection failed to become a predictor of mortality among those on Tenofovir-containing HAART.
HBsAg-positive status was associated with reduced survival and was an independent predictor of mortality in this African HIV cohort on HAART. However, Tenofovir annulled the impact of HBV on mortality of HIV patients in the present study cohort.
据报道，在感染艾滋病毒的非洲人群中，乙型肝炎感染率较高。然而，这种合并感染对接受长期高效抗逆转录病毒治疗（HAART）的非洲艾滋病毒感染者生存的影响仍知之甚少。我们调查了在西非人群中，乙肝病毒/艾滋病毒合并感染对接受抗逆转录病毒治疗的艾滋病毒感染者生存的影响。
这是一项基于诊所的队列研究，研究对象为西非尼日利亚的成年艾滋病毒感染者。在开始HAART治疗时，对9758名研究对象进行了乙肝和丙肝筛查。基于乙肝表面抗原状态，分别使用Kaplan-Meier生存模型和Cox比例风险模型来估计生存概率和确定死亡预测因素。所有患者在纳入研究前均签署了知情书面同意书；我们还获得了哈佛机构审查委员会对数据二次使用的许可。
患者的中位随访时间为41个月（四分位间距：30 - 62个月），在此期间，181名（1.9%）患者死亡。大多数死亡（143例，79.0%）发生在替诺福韦可用之前。在接受抗逆转录病毒治疗的患者中，随访74个月时，乙肝合并感染患者的生存率显著低于艾滋病毒单一感染患者（94%对97%；p = 0.0097）。一般来说，乙肝合并感染：乙肝表面抗原阳性/艾滋病毒阳性（风险率[HR]；1.5：95%置信区间1.09 - 2.11）、合并肺结核（HR；2.2：95%置信区间1.57 - 2.96）和男性（HR；1.5：95%置信区间1.08 - 2.00）是死亡的显著预测因素。根据替诺福韦的使用情况对患者进行分类，在接受含替诺福韦的HAART治疗的患者中，乙肝感染未能成为死亡的预测因素。
乙肝表面抗原阳性状态与生存率降低相关，并且是该接受HAART治疗的非洲艾滋病毒队列中死亡的独立预测因素。然而，在本研究队列中，替诺福韦消除了乙肝对艾滋病毒患者死亡率的影响。
