Wei Qian, Lin Haijiang, Ding Yingying, Liu Xing, Wu Qionghai, Shen Weiwei, Gao Meiyang, He Na
Department of Epidemiology, School of Public Health, Fudan University, and The Key Laboratory of Public Health Safety of Ministry of Education.
Key Laboratory of Health Technology Assessment of Ministry of Health, Fudan University.
Biosci Trends. 2017 Jul 24;11(3):274-281. doi: 10.5582/bst.2017.01071. Epub 2017 May 6.
We assessed the factors that influenced improvement or progression in human immunodeficiency virus (HIV)-infected patients who were receiving combination antiretroviral therapy (cART). This was a retrospective cohort study of HIV-infected patients receiving cART in Taizhou, Zhejiang, China, 2009-2015. Liver fibrosis was assessed by Fibrosis-4 (FIB-4) score. Improvement of liver fibrosis was defined as having > 30% decrease in FIB-4 from baseline, whereas progression of liver fibrosis was defined as having > 30% increase in FIB-4 score from baseline. A total of 955 HIV-infected patients were included. Of these, 808 (84.6%) were HIV-monoinfection, 125 (13.1%) were HIV/hepatitis B virus (HBV) coinfection and 29 (3.0%) were HIV/hepatitis C virus (HCV) coinfection. The median duration of treatment was 15 months. After treatment, 37.1% participants had > 30% decreases in FIB-4 index, 14.8% had > 30% increases in FIB-4 index, while the remaining 48.2% had stabilized FIB-4 index. In multivariate analysis, improvement of liver fibrosis was negatively associated with an older age, but was positively associated with baseline FIB-4 index and > 30% increases in CD4 cell count after ART. Progression of liver fibrosis was positively associated with an older age, but was negatively associated with gender and HIV transmission mode (male homosexual vs. male heterosexual, female heterosexual vs. male heterosexual), and baseline FIB-4 index. Our findings indicate that improvement of liver fibrosis could be achieved by early initiation of ART through better CD4 cell recovery. Liver fibrosis and hepatotoxicity associated with ART should be monitored as early as possible and throughout till the end of treatment, with special attention to the elderly and heterosexual men.
我们评估了接受联合抗逆转录病毒疗法（cART）的人类免疫缺陷病毒（HIV）感染患者病情改善或进展的影响因素。这是一项对2009年至2015年在中国浙江台州接受cART治疗的HIV感染患者进行的回顾性队列研究。通过Fibrosis-4（FIB-4）评分评估肝纤维化情况。肝纤维化改善定义为FIB-4较基线水平下降>30%，而肝纤维化进展定义为FIB-4评分较基线水平升高>30%。共纳入955例HIV感染患者。其中，808例（84.6%）为HIV单感染，125例（13.1%）为HIV/乙型肝炎病毒（HBV）合并感染，29例（3.0%）为HIV/丙型肝炎病毒（HCV）合并感染。治疗的中位持续时间为15个月。治疗后，37.1%的参与者FIB-4指数下降>30%，14.8%的参与者FIB-4指数升高>30%，其余48.2%的参与者FIB-4指数稳定。在多变量分析中，肝纤维化改善与年龄较大呈负相关，但与基线FIB-4指数以及抗逆转录病毒治疗（ART）后CD4细胞计数升高>30%呈正相关。肝纤维化进展与年龄较大呈正相关，但与性别和HIV传播方式（男同性恋与男异性恋、女异性恋与男异性恋）以及基线FIB-4指数呈负相关。我们的研究结果表明，通过早期启动ART实现更好的CD4细胞恢复可改善肝纤维化。应尽早并在整个治疗过程直至治疗结束监测与ART相关的肝纤维化和肝毒性，尤其要关注老年人和异性恋男性。
