French Audrey L, Hotton Anna, Young Mary, Nowicki Marek, Augenbraun Michael, Anastos Kathryn, Seaberg Eric, Rosenberg William, Peters Marion G
*CORE Center/Stroger Hospital of Cook County, Chicago, IL; †Department of Medicine, Rush University Medical Center, Chicago, IL; ‡Department of Medicine, Georgetown University Medical Center, Washington, DC; §Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA; ‖Department of Medicine, State University of New York, Downstate, Brooklyn, NY; ¶Department of Medicine, Montefiore Medical Center, Bronx, NY; #Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; **Institute for Liver and Digestive Health, Division of Medicine, University College London, London, United Kingdom; and ††Department of Medicine, University of California San Francisco, San Francisco, CA.
J Acquir Immune Defic Syndr. 2016 Jul 1;72(3):274-80. doi: 10.1097/QAI.0000000000000969.
Isolated hepatitis B core antibody (anti-HBc) is a common serologic finding in HIV-infected persons, but the clinical significance is uncertain. We studied HIV/hepatitis C virus (HCV)-infected women over time to determine whether the trajectory of liver disease progression is affected by isolated anti-HBc serologic status.
We performed serial enhanced liver fibrosis (ELF) markers on HIV/HCV-coinfected women to assess liver disease progression trajectory over time comparing women with isolated anti-HBc to women with either negative HB serologies, anti-HBs alone, or anti-HBc and anti-HBs. ELF, a serum marker that combines direct markers of extracellular matrix remodeling and fibrosis, was performed on serum stored biannually. Women with at least 3 ELF determinations and persistent HCV RNA positivity were included.
Three hundred forty-four women, including 132 with isolated anti-HBc and 212 with other serologic findings, were included. A median of 6 (interquartile range, 5-7) biannual ELF values was available for each woman, totaling 2119 visits. ELF increased over time from a median of 9.07 for women with isolated anti-HBc and 9.10 for those without isolated anti-HBc to 9.83 and 9.88, respectively, with no difference in degree of change or slope in the mixed-effects model including age, race, CD4 count, antiretroviral therapy, and drug and alcohol use. Factors independently associated with liver disease progression were older age, lower CD4, antiretroviral therapy nonuse, and Hispanic ethnicity.
Isolated anti-HBc serologic status was not associated with accelerated liver disease progression over a median of 9.5 years among HIV/HCV-coinfected women.
单独的乙肝核心抗体（抗-HBc）是HIV感染者常见的血清学表现，但其临床意义尚不确定。我们对感染HIV/丙型肝炎病毒（HCV）的女性进行了长期研究，以确定单独抗-HBc血清学状态是否会影响肝病进展轨迹。
我们对合并感染HIV/HCV的女性进行了系列增强肝纤维化（ELF）标志物检测，以评估随着时间推移肝病进展轨迹，将单独抗-HBc的女性与乙肝血清学阴性、仅抗-HBs或抗-HBc与抗-HBs均有的女性进行比较。ELF是一种结合细胞外基质重塑和纤维化直接标志物的血清标志物，对每半年储存的血清进行检测。纳入至少有3次ELF检测且HCV RNA持续阳性的女性。
共纳入344名女性，其中132名单独抗-HBc，212名有其他血清学表现。每位女性中位数为6次（四分位间距，5 - 7次）半年期ELF值，总计2119次检测。随着时间推移，单独抗-HBc女性的ELF从中位数9.07增加到9.83，无单独抗-HBc女性从9.10增加到9.88，在包括年龄、种族、CD4细胞计数、抗逆转录病毒治疗以及药物和酒精使用情况的混合效应模型中，变化程度或斜率无差异。与肝病进展独立相关的因素为年龄较大、CD4较低、未使用抗逆转录病毒治疗以及西班牙裔种族。
在合并感染HIV/HCV的女性中，单独抗-HBc血清学状态与9.5年中位数时间内肝病加速进展无关。
