Department of Epidemiology, School of Public Health, and the Key Laboratory of Public Health Safety of Ministry of Education, Fudan University.
Dehong Prefecture Center for Disease Control and Prevention.
Biosci Trends. 2019 Mar 14;13(1):32-39. doi: 10.5582/bst.2018.01299. Epub 2019 Feb 5.
End-stage liver disease (ESLD) is among leading causes of death for people living with HIV and HCV. Little is known how liver fibrosis score predicts mortality in HIV/HCV co-infected population under combination antiretroviral therapy (cART). A retrospective cohort study of 691 HIV/HCV co-infected patients receiving cART in Yunnan, China from 2005 to 2016 was carried out to explore the association between Fibrosis-4 index (FIB-4) and all-cause mortality. Cox proportional hazard models were used to estimate the hazard ratios (HRs) for FIB-4 and covariates. After a median follow-up of 4.8 years with a total follow-up time of 3,696 person-years (PY), 131 deaths occurred and the all-cause mortality was 3.5 per 100 PY. The mortality was 2.9 (95% CI: 2.3-3.5)/100 PY for the FIB-4 ≤ 3.25 group and 5.8 (4.2-7.4)/100 PY for the FIB-4 > 3.25 group at baseline. People with FIB-4 changed from mild to advanced group showed HR of 1.81 (95% CI: 1.01-3.25) for death, and with FIB-4 sustaining advanced showed HR of 3.11 (1.75-5.54), both compared to those with FIB-4 remained mild, while lower risk of death was observed among married people (HR = 0.63, 95% CI: 0.41-0.99) compared to unmarried, among those with most recent CD4 T cell counts between 200 and 350 cells/μL (0.50, 0.30-0.86) and > 350 cells/μL (0.25, 0.15-0.41) compared to CD4 under 200 cells/μL. Advanced and progressive liver fibrosis is a strong predictor of all-cause mortality in HIV/HCV co-infected patients under cART in China.
终末期肝病（ESLD）是导致 HIV 和 HCV 感染者死亡的主要原因之一。目前尚不清楚肝纤维化评分如何预测接受联合抗逆转录病毒治疗（cART）的 HIV/HCV 合并感染人群的死亡率。本研究在中国云南进行了一项回顾性队列研究，共纳入了 691 名接受 cART 的 HIV/HCV 合并感染患者，旨在探讨 Fibrosis-4 指数（FIB-4）与全因死亡率之间的关系。采用 Cox 比例风险模型估计 FIB-4 和协变量的风险比（HRs）。中位随访时间为 4.8 年，总随访时间为 3696 人年（PY），共发生 131 例死亡，全因死亡率为 3.5/100 PY。基线时 FIB-4≤3.25 组的全因死亡率为 2.9（95%CI：2.3-3.5）/100 PY，FIB-4＞3.25 组的全因死亡率为 5.8（4.2-7.4）/100 PY。FIB-4 从轻度变为重度的患者死亡风险 HR 为 1.81（95%CI：1.01-3.25），FIB-4 持续为重度的患者死亡风险 HR 为 3.11（1.75-5.54），均高于 FIB-4 持续为轻度的患者，而与未婚相比，已婚患者的死亡风险较低（HR=0.63，95%CI：0.41-0.99），与 CD4 细胞计数＜200 个/μL 的患者相比，CD4 细胞计数为 200-350 个/μL（0.50，0.30-0.86）和＞350 个/μL（0.25，0.15-0.41）的患者死亡风险较低。在中国接受 cART 的 HIV/HCV 合并感染患者中，晚期和进展性肝纤维化是全因死亡率的强有力预测因素。
