乙型肝炎病毒（HBV）与人类免疫缺陷病毒（HIV）合并感染患者的肝脏疾病谱：HBV-HIV 队列研究结果。
Spectrum of Liver Disease in Hepatitis B Virus (HBV) Patients Co-infected with Human Immunodeficiency Virus (HIV): Results of the HBV-HIV Cohort Study.
机构信息
Virginia Commonwealth University, Richmond, VA, USA.
University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
出版信息
Am J Gastroenterol. 2019 May;114(5):746-757. doi: 10.1038/s41395-018-0409-9.
BACKGROUND
Because most HBV/HIV co-infected patients on combination antiretroviral therapy (cART) have suppressed HBV DNA and normal liver enzymes, the histologic spectrum of liver disease in HBV/HIV coinfection is poorly defined. To address this gap in knowledge, we conducted a prospective study to comprehensively characterize liver disease severity assessed by liver biopsy in a well-defined cohort of HBV/HIV patients in North America receiving cART.
METHODS
Adult HIV/HBsAg positive patients on stable cART were recruited. Demographic, clinical, serological, and virological data were collected. Liver histology was assessed by a central pathology committee. The association of demographic, clinical, serologic, and virologic characteristics with liver histology was assessed using logistic regression.
RESULTS
In this cross-sectional analysis, the mean age of the cohort (N = 139) was 49 years; 92% were male, 51% were non-Hispanic black, 7% had at-risk alcohol use with a median duration of infections of 14 years. The median ALT was 28 IU/L and CD4 count was 568 cells/mm. Almost all (99%) were on cART. Three-fourths (75%) had undetectable HIV RNA (<20 copies/mL). HBeAg was positive in 62%, HBV DNA was below the limit of quantification (<20 IU/mL) in 57% and <1000 IU/ mL in 80%; 7% had incomplete viral suppression (HBV DNA ≥1000 IU/mL and HIV RNA <20 copies/mL). Liver histology (available in n = 114) showed significant periportal, lobular, and portal inflammation (scores ≥2) in 14%, 31%, and 22% respectively. Over a third (37%) had significant fibrosis (Ishak stage ≥2); 24% had advanced fibrosis (Ishak stage ≥3). Higher ALT (adjusted OR 1.19 per 10 IU/L; 95% CI [1.01, 1.41]; p = 0.03) and lower platelet count (adjusted OR 0.81 per 20,000 mm; 95% CI [0.67-0.97]; p = 0.02) but not HBV DNA were independently associated with advanced fibrosis.
CONCLUSIONS
In this cohort of patients with HBV/HIV coinfection receiving long-term cART with viral suppression, we observed significant fibrosis in more than one-third of patients.
背景
由于大多数接受联合抗逆转录病毒治疗（cART）的乙型肝炎病毒/艾滋病病毒（HBV/HIV）合并感染患者的乙型肝炎病毒 DNA 已被抑制且肝酶正常，因此 HBV/HIV 合并感染患者的肝脏疾病组织学谱尚不清楚。为了弥补这方面的知识空白，我们进行了一项前瞻性研究，对北美的 HBV/HIV 患者进行了综合评估，这些患者在接受 cART 的过程中，通过肝活检明确了肝脏疾病的严重程度。
方法
我们招募了接受稳定 cART 的 HIV/HBsAg 阳性成年患者。收集了人口统计学、临床、血清学和病毒学数据。由中心病理学委员会评估肝组织学。使用逻辑回归评估人口统计学、临床、血清学和病毒学特征与肝组织学的相关性。
结果
在这项横断面分析中，队列（n=139）的平均年龄为 49 岁；92%为男性，51%为非西班牙裔黑人，7%有高危饮酒史，感染中位数为 14 年。中位丙氨酸氨基转移酶（ALT）为 28IU/L，CD4 计数为 568 个细胞/mm。几乎所有患者（99%）都在接受 cART。四分之三（75%）的 HIV RNA 无法检测到（<20 拷贝/mL）。HBeAg 阳性率为 62%，HBV DNA 低于检测下限（<20IU/mL）的占 57%，<1000IU/mL 的占 80%；7%的患者存在不完全病毒抑制（HBV DNA≥1000IU/mL 且 HIV RNA<20 拷贝/mL）。肝组织学（可获得 n=114）显示门静脉周围、肝小叶和门脉炎症（评分≥2）分别为 14%、31%和 22%。超过三分之一（37%）有显著的纤维化（Ishak 分期≥2）；24%有晚期纤维化（Ishak 分期≥3）。较高的 ALT（每增加 10IU/L 的调整比值比 [OR]为 1.19；95%CI [1.01, 1.41]；p=0.03）和较低的血小板计数（每增加 20,000mm 的调整 OR 为 0.81；95%CI [0.67, 0.97]；p=0.02），但不是 HBV DNA，与晚期纤维化独立相关。
结论
在这项接受长期 cART 抑制病毒的 HBV/HIV 合并感染患者队列中，我们观察到超过三分之一的患者存在显著的纤维化。
Zotero 插件