Wu Lijuan, Jin Changzhong, Bai Shi, Davies Henry, Rao Heping, Liang Yong, Wu Nanping
Department of Nursing, School of Medicine, Taizhou University, Taizhou 318000, China.
State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
J Res Med Sci. 2015 Feb;20(2):127-32.
Co-infection of hepatitis virus is common in human immunodeficiency virus (HIV) infected adults in China. But little is known about hepatitis virus co-infection in pediatric HIV-infected subjects. The study aimed to investigate the impact of hepatitis B virus (HBV) and/or hepatitis C virus (HCV) co-infection and highly active antiretroviral therapy (HAART) on liver function of pediatric HIV-infected subjects.
A cohort study including 101 pediatric HIV-infected subjects with HBV/HCV co-infection and 44 pediatric comparators with HIV mono-infection was carried out in Henan Province of China from September 2011 to September 2012. All patients received HAART for 1-year. HBV and HCV infection was determined by antibody tests. HIV RNA load, CD4(+) T-cell counts and liver function were determined before and after HAART. The Student's t-test or a one-way ANOVA was used for normally distributed values and A Mann-Whitney U-test was performed for values without normal distribution using SPSS statistical package 18.0 (SPSS Inc.).
After HAART for 1-year, the median levels of viral load were decreased to lower limit of detection in 90.34% pediatric HIV-infected subjects with/without HBV/HCV co-infection (P < 0.001), and CD4(+) T-cell counts increased significantly (P < 0.001). Compared with the pre-HAART, mean level of alanine aminotransferase (ALT) in each group had a significant increase after HAART (P < 0.01). The mean levels of ALT and aspartate aminotransferase (AST) in nevirapine (NVP) based HAART group increased significantly after HAART (P < 0.01). Mean change values of ALT and AST were significantly higher in the NVP based regimen group than in the efavirenz (EFV) based regimen group (P < 0.01). For HIV/HBV/HCV co-infected patients, mean change values of ALT and AST in NVP-based HAART group was significantly higher than that in EFV-based HAART group (P < 0.01).
Highly active antiretroviral therapy can damage liver function in pediatric HIV-infected subjects, especially in those with HBV/HCV co-infection. NVP was more harmful to liver function of pediatric HIV-infected subjects than EFV.
在中国，人类免疫缺陷病毒（HIV）感染的成年人中，肝炎病毒合并感染很常见。但对于感染HIV的儿童患者中的肝炎病毒合并感染情况却知之甚少。本研究旨在调查乙型肝炎病毒（HBV）和/或丙型肝炎病毒（HCV）合并感染以及高效抗逆转录病毒治疗（HAART）对感染HIV的儿童患者肝功能的影响。
2011年9月至2012年9月在中国河南省开展了一项队列研究，纳入101例合并HBV/HCV感染的HIV感染儿童患者以及44例HIV单一感染的儿童对照者。所有患者均接受了1年的HAART治疗。通过抗体检测确定HBV和HCV感染情况。在HAART治疗前后测定HIV RNA载量、CD4(+) T细胞计数及肝功能。使用SPSS统计软件包18.0（SPSS公司）对正态分布的值采用Student's t检验或单因素方差分析，对非正态分布的值采用Mann-Whitney U检验。
HAART治疗1年后, 90.34%合并/未合并HBV/HCV感染的HIV感染儿童患者的病毒载量中位数降至检测下限（P < 0.001），且CD4(+) T细胞计数显著增加（P < 0.001）。与HAART治疗前相比，每组的丙氨酸氨基转移酶（ALT）平均水平在HAART治疗后均显著升高（P < 0.01）。基于奈韦拉平（NVP）的HAART治疗组的ALT和天冬氨酸氨基转移酶（AST）平均水平在HAART治疗后显著升高（P < 0.01）。基于NVP的治疗方案组的ALT和AST平均变化值显著高于基于依非韦伦（EFV）的治疗方案组（P < 0.01）。对于HIV/HBV/HCV合并感染患者，基于NVP的HAART治疗组的ALT和AST平均变化值显著高于基于EFV的HAART治疗组（P < 0.01）。
高效抗逆转录病毒治疗可损害感染HIV的儿童患者的肝功能，尤其是合并HBV/HCV感染的患者。NVP对感染HIV的儿童患者肝功能的损害比EFV更大。
