尼泊尔东部一家三级护理医院的横断面研究：HIV 感染者中乙型肝炎和丙型肝炎的合并感染。
Co-infection of Hepatitis B and Hepatitis C among HIV-infected patients: A cross-sectional study from tertiary care hospital of eastern Nepal.
机构信息
Department of Microbiology & Infectious Diseases, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
Department of Emergency Medicine, Kalaiya Hospital, Bara, Nepal.
出版信息
PLoS One. 2022 Mar 3;17(3):e0264791. doi: 10.1371/journal.pone.0264791. eCollection 2022.
INTRODUCTION
This study was conducted with an objective to analyze prevalence and risk factors associated with co-infection of hepatitis B virus (HBV) and hepatitis C virus (HCV) in HIV-positive patients with reference to their CD4+ T cell status.
MATERIALS AND METHODS
HIV-positive patients visiting the HIV clinic for CD4+ T cells testing at B.P. Koirala Institute of Health Sciences were tested for Hepatitis B and Hepatitis C. Data regarding age, gender, mode of HIV transmission, duration of HIV diagnosis, antiretroviral therapy status, antiretroviral therapy duration, hepatitis B or C status, and CD4+ T cells count were collected via face-to-face interview, and hospital records. The data were entered in Microsoft Excel 2019 v16.0 (Microsoft, WA, USA) and statistical analysis was performed by using statistical package for social sciences, IBM SPSS® v21 (IBM, Armonk, New York).
RESULTS
Out of 474 HIV-positive patients, HIV-HBV, HIV-HCV, and HIV-HBV-HCV co-infections were seen in 2.95% (14/474), 18.14% (86/474), and 2.53% (12/474) respectively. The primary route of infection was intra-venous drug use (IVDU) in those co-infected with HBV only (8, 57.14%), HCV only (46, 53.49%), and both HBV and HCV (8, 66.67%). HIV patients infected via IVDU were 2.40 times more likely to have HIV-HCV co-infection as compared to those infected via sexual route (AOR 2.40, 95% CI: 1.49,3.86). Similarly, HIV patients with CD4+ T cells count less than 350 cells/mm3 were more likely to have HIV-HBV-HCV co-infection as compared to those with CD4 count equal to and more than 350 cells/mm3 (AOR 13.84, 95% CI: 2.90,66.10).
CONCLUSION
HIV-positive patients are at high risk of hepatitis B and/or hepatitis C co-infection. Intravenous drug use, and lower CD4+T cells count are the most important risk predictors of co-infection. All HIV-positive patients should be carefully screened with hepatitis B and hepatitis C tests during their follow-up.
引言
本研究旨在分析 HIV 阳性患者中乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）合并感染的流行情况和相关危险因素，并参考其 CD4+T 细胞状态。
材料与方法
在 B.P. Koirala 健康科学研究所的 HIV 诊所就诊的 HIV 阳性患者接受了乙型肝炎和丙型肝炎检测。通过面对面访谈和医院记录收集了年龄、性别、HIV 传播途径、HIV 诊断持续时间、抗逆转录病毒治疗状况、抗逆转录病毒治疗持续时间、乙型肝炎或丙型肝炎状态以及 CD4+T 细胞计数等数据。将数据输入 Microsoft Excel 2019 v16.0（Microsoft，WA，USA），并使用 IBM SPSS® v21（IBM，Armonk，New York）统计软件包进行统计分析。
结果
在 474 名 HIV 阳性患者中，分别有 2.95%（14/474）、18.14%（86/474）和 2.53%（12/474）的患者合并感染 HIV-HBV、HIV-HCV 和 HIV-HBV-HCV。仅合并感染 HBV 的患者（8 例，57.14%）、仅合并感染 HCV 的患者（46 例，53.49%）和同时合并感染 HBV 和 HCV 的患者（8 例，66.67%）的主要感染途径为静脉吸毒（IVDU）。与性传播途径相比，IVDU 感染的 HIV 患者发生 HIV-HCV 合并感染的可能性高 2.40 倍（AOR 2.40，95%CI：1.49，3.86）。同样，CD4+T 细胞计数低于 350 个/mm3 的 HIV 患者发生 HIV-HBV-HCV 合并感染的可能性也高于 CD4 计数等于或大于 350 个/mm3 的患者（AOR 13.84，95%CI：2.90，66.10）。
结论
HIV 阳性患者存在乙型肝炎和/或丙型肝炎合并感染的高风险。静脉吸毒和较低的 CD4+T 细胞计数是合并感染的最重要的危险因素。所有 HIV 阳性患者在随访过程中都应进行乙型肝炎和丙型肝炎检测。
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