Kombewa Clinical Research Center, U.S. Army Medical Research Directorate-Africa, Kombewa, Kenya.
U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD.
J Acquir Immune Defic Syndr. 2021 Nov 1;88(3):310-313. doi: 10.1097/QAI.0000000000002760.
HIV and hepatitis B virus (HBV) coinfection can accelerate morbidity and mortality, especially in sub-Saharan Africa where both infections are common. Although inflammation contributes to disease progression, more information is needed to better understand the pathology. This study compared markers of cirrhosis and inflammation in HIV/HBV-coinfected individuals compared with monoinfected and uninfected patients.
The HIV/HBV-coinfected subjects from the Ugandan arm of the prospective African Cohort Study were selected for evaluation and matched by age and gender with HIV-monoinfected, HBV-monoinfected, and uninfected controls.
Plasma samples were used to quantify markers of immune activation and inflammation. The FIB-4 (a simple index to predict significant liver fibrosis) score was used to estimate liver fibrosis. Demographic and laboratory characteristics were compared across the groups.
Together, 31 HIV/HBV-coinfected participants were identified and compared with 62 HIV-monoinfected, 7 HBV-monoinfected, and 62 uninfected controls. The HIV/HBV-coinfected group had generally higher levels of inflammation. Most notably, matrix metalloproteinase-2, matrix metalloproteinase-9, and fibroblast growth factor-19 levels were dysregulated among the HIV/HBV-coinfected individuals. Furthermore, the FIB-4 score was higher in the HIV/HBV-coinfected group compared with the HIV-monoinfected group and revealed that 11% of HIV/HBV-coinfected individuals had evidence of undiagnosed advanced liver disease.
Differences in levels of inflammation exist between individuals with HIV/HBV coinfection compared with monoinfected and uninfected controls. A distinct signature of inflammation was associated with HIV/HBV coinfection that could reflect the mechanism of liver fibrosis and increased risk for disease progression. Finally, there may be an underappreciated amount of undiagnosed advanced liver disease in sub-Saharan Africa.
HIV 和乙型肝炎病毒 (HBV) 合并感染会加速发病率和死亡率，尤其是在这两种感染都很常见的撒哈拉以南非洲地区。尽管炎症会导致疾病进展，但我们需要更多信息来更好地了解其病理学。本研究比较了 HIV/HBV 合并感染个体与单感染和未感染患者的肝硬化和炎症标志物。
从乌干达的前瞻性非洲队列研究中选择了 HIV/HBV 合并感染的受试者，并根据年龄和性别与 HIV 单感染、HBV 单感染和未感染对照组进行匹配。
使用血浆样本来量化免疫激活和炎症标志物。使用 FIB-4（一种简单的预测显著肝纤维化的指标）评分来估计肝纤维化。比较各组的人口统计学和实验室特征。
共确定了 31 名 HIV/HBV 合并感染的参与者，并与 62 名 HIV 单感染、7 名 HBV 单感染和 62 名未感染的对照组进行了比较。HIV/HBV 合并感染组的炎症水平普遍较高。特别是基质金属蛋白酶-2、基质金属蛋白酶-9 和成纤维细胞生长因子-19 的水平在 HIV/HBV 合并感染个体中失调。此外，与 HIV 单感染组相比，HIV/HBV 合并感染组的 FIB-4 评分更高，并且表明 11%的 HIV/HBV 合并感染个体存在未确诊的晚期肝病证据。
与单感染和未感染对照组相比，HIV/HBV 合并感染个体的炎症水平存在差异。与 HIV/HBV 合并感染相关的炎症特征可能反映了肝纤维化的机制和疾病进展的风险增加。最后，在撒哈拉以南非洲地区可能存在未被充分认识的大量未确诊的晚期肝病。
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