Xie Jing, Han Yang, Qiu Zhifeng, Li Yijia, Li Yanling, Song Xiaojing, Wang Huanling, Thio Chloe L, Li Taisheng
Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Division of Infectious Diseases, Johns Hopkins Hospital, Johns Hopkins University School of Medicine Baltimore, MA, USA;
J Int AIDS Soc. 2016 Mar 14;19(1):20659. doi: 10.7448/IAS.19.1.20659. eCollection 2016.
Liver disease related to hepatitis B (HBV) and hepatitis C (HCV) may temper the success of antiretroviral therapy (ART) in China. Limited data exist on their prevalence in HIV-positive Chinese. A multi-centre, cross-sectional study was carried out to determine the prevalence and disease characteristics of HBV and HCV co-infection in HIV-positive patients across 12 provinces.
HIV-positive ART-naïve patients were recruited from two parent cohorts established during November 2008-January 2010 and August 2012-September 2014. Hepatitis B surface antigen (HBsAg), hepatitis B e antigen and HCV antibody (anti-HCV) status were retrieved from parent databases at the visit prior to ART initiation. HBV DNA was then determined in HBsAg+ patients. HCV RNA was quantified in anti-HCV+ patients. Aspartate aminotransferase-to-platelet ratio index (APRI) and the fibrosis-4 (FIB4) were calculated. Chi-square test, Kruskal-Wallis test and logistic regression were used for statistical analysis, as appropriate.
Of 1944 HIV-positive patients, 186 (9.5%) were HIV-HBV co-infected and 161 (8.3%) were HIV-HCV co-infected. The highest HIV-HBV prevalence (14.5%) was in Eastern China while the highest HIV-HCV prevalence was in the Central region (28.2%). HIV-HBV patients had lower median CD4 + T cell count (205 cells/μL) than either HIV monoinfected (242 cells/μL, P = 0.01) or HIV-HCV patients (274 cells/μL, P = 0.001). Moderate-to-significant liver disease was present in > 65% of the HIV-HCV, ~ 35% of the HIV-HBV and ~ 20% of the HIV monoinfected patients. Independent associations with moderate-to-significant liver disease based on APRI included HBV (Odds ratio, OR 2.37, P < 0.001), HCV (OR 9.64, P < 0.001), CD4 count ≤ 200 cells/μL (OR 2.55, P < 0.001) and age ≥ 30 years (OR 1.80, P = 0.001).
HBV and HCV prevalence is high in HIV-positive Chinese and differs by geographic region. HBV and HCV co-infection and HIV monoinfection are risks for moderate-to-significant liver disease. Only HIV-HBV is associated with greater HIV-related immunosuppression. Incorporating screening and management of hepatitis virus infections into Chinese HIV programmes is needed.
在中国，与乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）相关的肝脏疾病可能会影响抗逆转录病毒疗法（ART）的治疗效果。关于HIV阳性的中国人中HBV和HCV感染率的数据有限。我们开展了一项多中心横断面研究，以确定12个省份HIV阳性患者中HBV和HCV合并感染的患病率及疾病特征。
从2008年11月至2010年1月以及2012年8月至2014年9月期间建立的两个母队列中招募未接受过ART治疗的HIV阳性患者。在开始ART治疗前的访视中，从母数据库中获取乙型肝炎表面抗原（HBsAg）、乙型肝炎e抗原和HCV抗体（抗-HCV）状态。然后对HBsAg阳性患者进行HBV DNA检测。对抗-HCV阳性患者进行HCV RNA定量检测。计算天冬氨酸转氨酶与血小板比值指数（APRI）和纤维化-4（FIB4）。根据情况，使用卡方检验、Kruskal-Wallis检验和逻辑回归进行统计分析。
在1944例HIV阳性患者中，186例（9.5%）为HIV-HBV合并感染，161例（8.3%）为HIV-HCV合并感染。HIV-HBV感染率最高（14.5%）的地区是中国东部，而HIV-HCV感染率最高的地区是中部地区（28.2%）。HIV-HBV患者的CD4 + T细胞计数中位数（205个/μL）低于HIV单感染患者（242个/μL，P = 0.01）和HIV-HCV患者（274个/μL，P = 0.001）。超过65%的HIV-HCV患者、约35%的HIV-HBV患者和约20%的HIV单感染患者存在中度至重度肝脏疾病。基于APRI，与中度至重度肝脏疾病的独立关联因素包括HBV（比值比，OR 2.37，P < 0.001）、HCV（OR 9.64，P < 0.001）、CD4细胞计数≤200个/μL（OR 2.55，P < 0.001）和年龄≥30岁（OR 1.80，P = 0.001）。
HIV阳性的中国人中HBV和HCV感染率较高，且因地理区域而异。HBV和HCV合并感染以及HIV单感染是中度至重度肝脏疾病的危险因素。只有HIV-HBV与更严重的HIV相关免疫抑制有关。需要将肝炎病毒感染的筛查和管理纳入中国的HIV防治项目中。
