您的位置：山东大学 -> 科技期刊社 -> 《山东大学学报（医学版）》

山东大学学报 (医学版) ›› 2020, Vol. 58 ›› Issue (1): 60-66.doi: 10.6040/j.issn.1671-7554.0.2019.1166

• • 上一篇    

山东省单纯艾滋病病毒感染与合并乙型肝炎病毒感染者抗病毒治疗效果及相关因素

刘翠晓1, 朱晓艳2, 张娜2, 黄鹏翔2, 王国永2, 康殿民1,2,3   

  1. 1.山东大学公共卫生学院流行病学系, 山东 济南 250012;2.山东省疾病预防控制中心艾滋病防制所, 山东 济南 250014;3.山东省传染病预防控制重点实验室, 山东 济南 250014
  • 发布日期:2022-09-27
  • 通讯作者: 康殿民. E-mail:dmkang66@163.com
  • 基金资助:
    “十二五”艾滋病和病毒性肝炎等重大传染病防治科技重大专项(2014ZX10001002-001-003)

Antiretrovial treatment effect and related factors of patients with human immunodeficiency virus infection and hepatitis B virus co-infection in Shandong Province

LIU Cuixiao1, ZHU Xiaoyan2, ZHANG Na2, HUANG Pengxiang2, WANG Guoyong2, KANG Dianmin1,2,3   

  1. 1. Department of Epidemiology, School of Public Health, Shandong University, Jinan 250012, Shandong, China;
    2. Division of AIDS Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250014, Shandong, China;
    3. Key Laboratory of Prevention and Control of Infections Diseases in Shandong Province, Jinan 250014, Shandong, China
  • Published:2022-09-27

PDF (PC)

190

摘要： 目的 了解山东省合并乙型肝炎病毒(HBV)感染与单纯感染艾滋病(AIDS)病毒(HIV)患者的抗病毒治疗效果及相关影响因素。 方法 从2015~2017年山东省艾滋病抗病毒治疗数据库中筛选符合条件的HIV/AIDS患者500例,分为HIV单纯感染组(n=168)和HIV/HBV合并感染组(n=332),年龄分别为(35.41±10.24)岁和(34.75±9.22)岁,分析比较两组患者基本情况、抗病毒治疗12个月后相关指标变化情况,使用Logistic回归模型进行治疗效果的相关因素分析。 结果 两组均以男性、未婚、性途径感染为主。抗病毒治疗12个月后,HIV单纯感染组CD4+T淋巴细胞中位数从315.5个/μL上升至439.0个/μL,HIV/HBV合并感染组从349.5个/μL增加至491.0个/μL。HIV单纯感染组与HIV/HBV合并感染组患者出现免疫学失败的比例分别为16.3%和44.6%;病毒学失败比例分别为7.5%和13.1%。两组患者治疗效果多因素Logistic分析显示,出现免疫学失败与合并HBV感染(OR=1.619,95%CI:1.061~2.469)、年龄35~44岁(OR=2.695,95%CI:1.145~6.345)和≥45岁(OR=3.101,95%CI:1.291~7.450)有关;病毒学失败的发生则与合并HBV感染(OR=2.156,95%CI:1.142~4.070)、临床分期Ⅲ/Ⅳ期(OR=2.443,95%CI:1.102~5.416)有关。 结论 合并HBV感染者治疗效果不如单纯感染者理想,应加强HIV/AIDS患者乙型病毒性肝炎的筛查及有效管理,针对不同人群选择合适的治疗方案,提高抗病毒治疗的有效性。

关键词: 乙型肝炎病毒, 艾滋病病毒, 合并感染, 抗病毒治疗

Abstract: Objective To investigate the treatment effect and its related factors among human immunodeficiency virus(HIV)/ acquired immunodeficiency syndrome(AIDS)patients with or without HBV co-infection in Shandong Province. Methods Data of 500 HIV/AIDS patients were collected from the Shandong AIDS Antiviral Treatment Database during 2015 and 2017. The patients were divided into the HIV infection group(n=168)and the HIV/HBV co-infection group(n=332), aged(35.41±10.24)and(34.75±9.22)years, respectively. The basic situation of patients were analyzed, and the changes of related indicators after treatment for 12 months were compared. Logistic regression model was used to analyze the related factors of the antiretroviral therapy effect. Results Most of patients were male, unmarried, 山 东 大 学 学 报 (医 学 版)58卷1期 -刘翠晓,等.山东省单纯艾滋病病毒感染与合并乙型肝炎病毒感染者抗病毒治疗效果及相关因素 \=-and infected by sexual transmission. After treatment for 12 months, the median of CD4+ T lymphocyte increased from 315.5/μL to 439.0/μL in HIV infection group, and from 349.5/μL to 491.0/μL in HIV/HBV co-infection group. The proportion of immunological failure was 16.3% in the HIV infection group and 44.6% in the HIV/HBV co-infection group. The proportion of virological failure was 7.5% in the HIV infection group and 13.1% in the HIV/HBV co-infection group. Multivariate Logistic analysis of treatment outcomes showed that immunological failure was associated with HBV co-infection(OR=1.619, 95%CI: 1.061-2.469), 35-44 years old (OR=2.695, 95%CI: 1.145-6.345)and older than 45 years old (OR=3.101, 95%CI: 1.291-7.450). The occurrence of virological failure was associated with HBV co-infection(OR=2.156, 95%CI: 1.142-4.070)and clinical stage III or IV (OR=2.443, 95%CI: 1.102-5.416). Conclusion The treatment effect of patients with HIV/HBV co-infection is not as good as that with HIV simple infection. Screening and effective management of HBV in HIV/AIDS patients should be strengthened. Choosing the suitable treatment drug for different people is crucial and can improve the effectiveness of antiviral treatment.

Key words: Hepatitis B virus, Human immunodeficiency virus, Co-infection, Antiretroviral therapy

中图分类号: 

  • R512.91
[1] Xie J, Han Y, Qiu Z, et al. Prevalence of hepatitis B and C viruses in HIV-positive patients in China: a cross-sectional study[J]. J Int AIDS Soc, 2016, 19(1): 20659. doi: 10.7448/IAS.19.1.20659.
[2] Sun HY, Sheng WH, Tsai MS, et al. Hepatitis B virus coinfection in human immunodeficiency virus-infected patients: a review[J]. World J Gastroenterol, 2014, 20(40): 14598-14614.
[3] Adekunle AE, Oladimeji AA, Temi AP, et al. Baseline CD4+ T lymphocyte cell counts, hepatitis B and C viruses seropositivity in adults with Human Immunodeficiency Virus infection at a tertiary hospital in Nigeria[J]. Pan Afr Med J, 2011, 9: 6.
[4] Easterbrook P, Sands A, Harmanci H. Challenges and priorities in the management of HIV/HBV and HIV/HCV coinfection in resource-limited sett-ings[J]. Semin Liver Dis, 2012, 32(2): 147-157.
[5] Kourtis AP, Bulterys M, Hu DJ, et al. HIV-HBV coinfection—a global challenge [J]. N Engl J Med, 2012, 366(19): 1749-1752.
[6] Prussing C, Chan C, Pinchoff J, et al. HIV and viral hepatitis co-infection in New York City, 2000-2010: prevalence and case characteristics[J]. Epidemiol Infect, 2015, 143(7): 1408-1416.
[7] 赵燕. HIV感染者个案管理实用手册[M]. 北京: 人民卫生出版社, 2018.
[8] 中华医学会感染学分会艾滋病丙型肝炎学组. 中国艾滋病诊疗指南(2018版)[J]. 新发传染病电子杂志, 2019, 4(2): 65-84. Chinese Medical Association Infectious Diseases Branch AIDS Hepatitis C Professional Group. Chinese guidelines for diagnosis and treatment of HIV/AIDS(2018)[J]. Electronic Journal of Emerging Infectious Diseases, 2019, 4(2): 65-84.
[9] Van Griensven J, Phirum L, Choun K, et al. Hepatitis B and C co-infection among HIV-infected adults while on antiretroviral treatment: long-term survival, CD4 cell count recovery and antiretroviral toxicity in Cambodia[J]. PLoS One, 2014, 9(2): e88552. doi: 10.1371/journal.pone.0088552.
[10] Zhang F, Zhu H, Wu Y, et al. HIV, hepatitis B virus, and hepatitis C virus co-infection in patients in the China National Free Antiretroviral Treatment Program, 2010-12: a retrospective observational cohort study[J]. Lancet Infect Dis, 2014, 14(11): 1065-1072.
[11] 杨兴光, 钱跃升, 张娜, 等. 山东省艾滋病流行特征分析[J]. 中国病原生物学杂志, 2018, 13(1): 68-71. YANG Xingguang, QIAN Yuesheng, ZHANG Na, et al. Analysis of the epidemiological characteristics of HIV/AIDS in Shandong Province[J]. Journal of Pathogen Biology, 2018, 13(1): 68-71.
[12] 胡庆玲, 谢元林. 人类免疫缺陷病毒合并乙型肝炎病毒感染患者高效抗反转录病毒治疗效果和肝脏损伤研究[J]. 广东医学, 2017, 38(7): 1029-1031. HU Qingling, XIE Yuanlin. Response and liver injury of highly active antiretroviral therapy on human immunodeficiency virus co-infection[J]. Guangdong Medical Journal, 2017, 38(7): 1029-1031.
[13] 汪明勋. 对艾滋病合并HBV感染患者进行高效抗逆转录病毒治疗的效果研究[J]. 当代医药论丛, 2018, 16(22): 8-9. WANG Mingxun. Effect of highly effective antiretroviral therapy for the patients of HIV with HBV[J]. Contemporary Medical Symposium, 2018, 16(22): 8-9.
[14] Sheng WH, Chen MY, Hsieh SM, et al. Impact of chronic hepatitis B virus(HBV)infection on outcomes of patients infected with HIV in an area where HBV infection is hyperendemic[J]. Clin Infect Dis, 2004, 38(10): 1471-1477.
[15] Su S, Fairley CK, Sasadeusz J, et al. HBV, HCV, and HBV/HCV co-infection among HIV-positive patients in Hunan province, China: regimen selection, hepatotoxicity, and antiretroviral therapy outcome[J]. J Med Virol, 2017, 90(3): 518-525.
[16] Zhu J, Yang W, Feng Y, et al. Treatment effects of the differential first-line antiretroviral regimens among HIV/HBV coinfected patients in southwest China: an observational study[J]. Sci Rep, 2019, 9(1): 1006. doi: 10.1038/s41598-018-37148-8.
[17] Chen M, Wong WW, Law MG, et al. Hepatitis B and C co-infection in HIV patients from the TREAT Asia HIV Observational Database: analysis of risk factors and survival[J]. PLoS One, 2016, 11(3): e0150512. doi: 10.1371/journal.pone.0150512.
[18] 毛霖, 李武, 汪习成. HIV/HBV合并感染研究进展[J]. 传染病信息, 2014, 27(2): 126-128. MAO Lin, LI Wu, WANG Xicheng. Research progress of HIV/HBV co-infection[J]. Infectious Disease Information, 2014, 27(2): 126-128.
[19] Wandeler G, Gsponer T, Bihl F, et al. Hepatitis B virus infection is associated with impaired immunological recovery during antiretroviral therapy in the Swiss HIV cohort study[J]. J Infect Dis, 2013, 208(9): 1454-1458.
[20] 聂源, 兰芸, 李锋, 等. HBeAg状态对HIV/HBV合并感染者免疫重建的影响[J]. 国际流行病学传染病学杂志, 2018, 45(5): 293-296. NIE Yuan, LAN Yun, LI Feng, et al. Impact of HBeAg status on immune reconstitution in HIV/HBV co-infected patients[J]. International Journal of Epidemiology and Infectious Disease, 2018, 45(5): 293-296.
[21] 郑武, 笪琴, 张薇, 等. 湖北省接受艾滋病HAART患者CD4+T淋巴细胞变化趋势及影响因素[J]. 实用预防医学, 2018, 25(11): 1325-1328. ZHENG Wu, DA Qin, ZHANG Wei, et al. Changing trend of CD4+T lymphocyte count and its influencing factors in HIV/AIDS patients with HAART in Hubei Province[J]. Practical Preventive Medicine, 2018, 25(11): 1325-1328.
[22] 粟斌, 夏炜, 姜太一, 等. 老年HIV感染群体的扩大已呈不容低估的发展趋势[J]. 中国艾滋病性病, 2019, 25(2): 201-203. SU Bin, XIA Wei, JIANG Taiyi, et al. Expansion of the elderly HIV infection group—a trend to be never underestimated[J]. Chinese Journal of AIDS & STD, 2019, 25(2): 201-203.
[23] 陈国春, 卫峥, 马波, 等. 艾滋病患者高效抗病毒治疗后免疫重建及预后影响因素研究[J]. 中华医院感染学杂志, 2018, 28(22): 3414-3417, 3421. CHEN Guochun, WEI Zheng, MA Bo, et al. Influencing factors for immune reconstruction and prognosis of AIDS patients after highly active antiretroviral therapy[J]. Chinese Journal of Nosocomiology, 2018, 28(22): 3414-3417, 3421.
[1] 林玉玺,李传玺,王霖,马伟. 男男性行为人群性取向告知与艾滋病病毒检测:社会规范与自我效能的链式中介作用[J]. 山东大学学报 (医学版), 2021, 59(3): 113-119.
[2] 卯怡杰,张旭峰,刘双德,刘晓立,焉杰克,徐东升,潘稳固,田川. 直接抗病毒治疗肾移植术后丙肝患者的疗效和安全性[J]. 山东大学学报 (医学版), 2019, 57(1): 75-80.
[3] 毕涛,卢倩倩,孙传东. 腺病毒介导HBx对人淋巴细胞影响的体外实验[J]. 山东大学学报 (医学版), 2018, 56(7): 15-20.
[4] 袁源,司珩,刘宏伟,刘春华,王哲,阮玉华,邢辉. 不同时期抗病毒治疗对艾滋病患者耐药产生的影响分析[J]. 山东大学学报（医学版）, 2016, 54(9): 77-81.
[5] 杨沛华, 谢永忠, 夏金荣, 杜传策, 包月妃, 周观林, 王利勤. 非免疫清除期乙型肝炎患者行肾结石手术后HBV-LP、HBV-M及HBV-DNA变化研究[J]. 山东大学学报（医学版）, 2014, 52(S1): 104-105.
[6] 符晓莉，王磊，刘峰. 乙肝病毒感染不同阶段血清HBsAg定量值及其与HBV DNA水平和年龄的相关性[J]. 山东大学学报(医学版), 2013, 51(5): 94-98.
[7] 徐慧1，王义国2，刘长虹2，刘倩2，杜娟3. HBV在HK-2细胞内的表达及对其转分化的影响[J]. 山东大学学报(医学版), 2013, 51(3): 15-20.
[8] 张立新1，2，安勇2，徐皖苏3，张孝国2，刘靓雯3，于进红2，张琴冈2. 慢性丙型肝炎患者血清白介素-8表达水平与基因型及抗病毒治疗的相关性[J]. 山东大学学报(医学版), 2010, 48(8): 100-102.
[9] 邢培祥a,邹明瑾a,邢全台b,王洪春a,汪运山 . 前炎性细胞因子基因多态性与乙型肝炎病毒感染的关系[J]. 山东大学学报(医学版), 2007, 45(12): 1229-1233.
[10] 卜范峰,鲁艳芹,韩金祥,王丽娜,冯照雷,沈忠林,高刚 . 乙型肝炎病毒基因型、拉米夫定耐药突变的RFLP检测及临床相关性分析[J]. 山东大学学报(医学版), 2007, 45(11): 1139-1143.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
版权所有 © 2018 《山东大学学报(医学版)》编辑部　
地址:山东大学科技期刊社（济南市历城区山大南路27号山东大学中心校区明德楼B座721室） 电话: 0531-88366918 E-mail: xbyxb@sdu.edu.cn
本系统由北京玛格泰克科技发展有限公司设计开发