摘要
目的了解乙型肝炎病毒(hepatitis B virus,HBV)合并人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染对抗反转录病毒治疗(anti-retroviral therapy,ART)效果的影响。方法纳入2016年9月至2019年10月重庆市公共卫生医疗救治中心收治的269例HIV感染者,将其分为HIV单独感染组和HBV合并HIV感染组,比较2组患者ART启动时和ART后不同时间点(2、4、8、12、24、36、48和96周)的肝功能、CD4^(+)T淋巴细胞计数、HIV RNA变化情况。统计学分析采用独立样本t检验、秩和检验和χ^(2)检验。结果HIV单独感染组145例,HBV合并HIV感染组124例。ART启动时两组患者肝功能指标[天冬氨酸转氨酶(t=9.566)、丙氨酸转氨酶(t=-4.652)、总胆红素(t=-25.476)]差异均无统计学意义(均P>0.05)。ART后24、48和96周时,HIV单独感染组与HBV合并HIV感染组CD4^(+)T淋巴细胞计数分别为(305.9±156.9)/μL比(266.2±172.5)/μL、(388.5±226.1)/μL比(380.8±287.4)/μL、(369.5±191.4)/μL比(453.6±179.6)/μL;ART后48、72和96周时,CD4^(+)T淋巴细胞计数增长值为121.0(-52.5,144.5)/μL比156.0(-35.8,185.8)/μL、139.0(-116.0,176.8)/μL比114.5(-59.5,229.0)/μL、-91.0(-110.0,153.3)/μL比-94.0(-130.8,114.3)/μL,差异均无统计学意义(t=-0.516、-0.066、-1.414、Z=-1.715、-0.802、-1.602,均P>0.05)。ART后24、48和96周时,HIV单独感染组的HIV RNA抑制率分别为89.7%(130/145)、96.6%(140/145)和96.6%(140/145),HBV合并HIV感染组分别为87.1%(108/124)、92.7%(115/124)和94.4%(117/124),差异均无统计学意义(χ^(2)=0.026、0.053、0.017,均P>0.05)。ART后第2周、第4周HIV单独感染组肝功能异常率分别为3.4%(5/145)、6.2%(9/145),低于HBV合并HIV感染组的21.0%(26/124)、13.7%(17/124),差异均有统计学意义(χ^(2)=20.121、4.309,均P<0.05);而第8周[10.3%(15/145)比9.7%(12/124)]、第12周[9.0%(13/145)比9.7%(12/124)]、第24周[9.7%(14/145)比8.9%(11/124)]、第36周[9.7%(14/145)比10.5%(13/124)]、第48周[8.3%(12/145)比8.1%(10/124)]、第96周[2.8%(4/145)比0(0/124)]的肝功能异常率差异均无统计学意义(χ^(2)=0.330、0.040、0.049、0.051、0.004、3.472,均P>0.05)。结论合并HBV感染对HIV感染者的ART效果无不良影响。
Objective To investigate the influence of hepatitis B virus(HBV)combined with human immunodeficiency virus(HIV)infection on the efficacy of anti-retroviral therapy(ART).Methods The data of 269 HIV-infected patients treated in Chongqing Public Health Medical Center from September 2016 to October 2019 were collected.The patients were divided into HIV monoinfection group and HIV/HBV coinfection group.The changes in liver function,CD4^(+)T lymphocyte count,and HIV RNA level between the two groups were compared when ART started and at different time points(2,4,8,12,24,36,48,and 96 weeks)after ART started.Statistical analysis were performed by independent sample t test,rank sum test and chi-square test.Results A total of 145 patients with HIV monoinfection and 124 patients with HIV/HBV coinfection were collected.There were no statistically significant differences in liver function indexes(aspartate aminotransferase(t=9.566),alanine aminotransferase(t=-4.652)and total bilirubin(t=-25.476))between the two groups of patients when ART started(all P>0.05).At 24,48 and 96 weeks after ART,the CD4^(+)T lymphocyte counts in the HIV monoinfection group and the HIV/HBV coinfection group were(305.9±156.9)/μL vs(266.2±172.5)/μL,(388.5±226.1)/μL vs(380.8±287.4)/μL and(369.5±191.4)/μL vs(453.6±179.6)/μL,respectively.At 48,72 and 96 weeks after ART,the CD4+T lymphocyte count increasing values were 121.0(-52.5,144.5)/μL vs 156.0(-35.8,185.8)/μL,139.0(-116.0,176.8)/μL vs 114.5(-59.5,229.0)/μL and-91.0(-110.0,153.3)/μL vs-94.0(-130.8,114.3)/μL,respectively.The differences were all not statistically significant(t=-0.516,-0.066 and-1.414,Z=-1.715、-0.802 and-1.602,respectively,all P>0.05).At 24,48,and 96 weeks after ART,the HIV RNA inhibition rates in the HIV monoinfection group were 89.7%(130/145),96.6%(140/145),and 96.6%(140/145),respectively,and those in the HIV/HBV coinfection group were 87.1%(108/124),92.7%(115/124)and 94.4%(117/124),respectively.The differences were all not statistically significant(χ^(2)=0.026,0.053 and 0.017,respectively,all P>0.05).In the second and fourth weeks after ART,the abnormal liver function rates of the HIV monoinfection group were 3.4%(5/145)and 6.2%(9/145),respectively,which were lower than those in the HIV/HBV coinfection group(21.0%(26/124)and 13.7%(17/124),respectively).The differences were both statistically significant(χ^(2)=20.121 and 4.309,respectively,both P<0.05).However,the abnormal liver function rates in the two group in the 8th week after ART were 10.3%(15/145)and 9.7%(12/124),respectively,and those in the 12th week were 9.0%(13/145)and 9.7%(12/124),respectively,and those in the 24th week were 9.7%(14/145)and 8.9%(11/124),respectively,and those in the 36th week were 9.7%(14/145)and 10.5%(13/124),respectively,and those in the 48th week were 8.3%(12/145)and 8.1%(10/124),respectively,and those in the 96th week were 2.8%(4/145)and 0(0/124),respectively.The differences were all not statistically significant(χ^(2)=0.330,0.040,0.049,0.051,0.004 and 3.472,respectively,all P>0.05).Conclusion HBV coinfection has no adverse effect on the ART effect of HIV-infected patients.
作者
鲁雁秋
谭顺
白艳
刘金玉
王静
陈耀凯
Lu Yanqiu;Tan Shun;Bai Yan;Liu Jinyu;Wang Jing;Chen Yaokai(Department of Infectious Diseases,Chongqing Public Health Medical Center,Chongqing 400036,China;Department of Nursing,Chongqing Public Health Medical Center,Chongqing 400036,China;Department of Laboratory,Chongqing Public Health Medical Center,Chongqing 400036,China)
出处
《中华传染病杂志》
CAS
CSCD
2021年第5期276-280,共5页
Chinese Journal of Infectious Diseases
基金
"十三五"国家科技重大专项(2018ZX10302104、2017ZX10202101-001-016、2017ZX10202101-001-011)
重庆市公共卫生医疗救治中心青年科研创新基金(19QNKYXM09)
佑安肝病感染病专科医疗联盟科研专项基金(LM202021)。
