CAJ | 학술논문

目的了解HBV感染对AIDS患者联合抗反转录病毒治疗(cART)效果的影响.方法对HIV、HBV合并感染者78例和AIDS患者156例定期进行CD4+T淋巴细胞、HIV RNA、HBV血清学标志物和肝功能检测,并记录其生存情况,比较两组患者cART期间免疫学和病毒学应答的差异.计数资料采用卡方检验,计量资料采用t检验,非正态分布的计量资料采用两独立样本非参数检验.结果 cART第42个月时,同一治疗时间的CD4+T淋巴细胞和HIV RNA水平在HIV、HBV合并感染者与单纯AIDS患者间比较,差异均无统计学意义；cART第48、54和60个月时,HIV、HBV合并感染者免疫学和病毒学应答水平均低于单纯AIDS患者.HIV、HBV合并感染者在cART后第12、24、36、48和60个月时,13例患者中有3例在各时间点均表现为HBeAg阴转；抗-HBe阳转率分别为32.1％(9/28)、50.0％(14/28)、53.6％(15/28)、64.3％(18/28)和71.4％(20/28),阳转率逐年增高(x2=10.189,P=0.037); HBV DNA阴转率分别为95.1％(39/41)、82.9％(34/41)、68.3％(28/41)、43.9％(18/41)和43.9％(18/41),阴转率逐年下降(x2=29.982,P=0.000);肝功能异常率分别为32.1％(25/78)、51.4％(38/74)、33.8％(22/65)、47.9％(23/48)及6.7％(3/45),各时间点差异有统计学意义(x2=28.053,P=0.000).HIV、HBV合并感染者及单纯AIDS患者的病死率分别为24.4％(19/78)和5.1％(8/156),差异有统计学意义(x2=18.841,P＜0.01),且HIV、HBV合并感染者84.2％死于HBV相关的终末期肝病.结论合并HBV感染可影响cART的远期疗效,终末期肝病是HIV、HBV合并感染者接受cART后的首要死因.
목적 료해HBV감염대AIDS환자연합항반전록병독치료(cART)효과적영향.방법 대HIV、HBV합병감염자78례화AIDS환자156례정기진행CD4+T림파세포、HIV RNA、HBV혈청학표지물화간공능검측,병기록기생존정황,비교량조환자cART기간면역학화병독학응답적차이.계수자료채용잡방검험,계량자료채용t검험,비정태분포적계량자료채용량독립양본비삼수검험.결과 cART제42개월시,동일치료시간적CD4+T림파세포화HIV RNA수평재HIV、HBV합병감염자여단순AIDS환자간비교,차이균무통계학의의；cART제48、54화60개월시,HIV、HBV합병감염자면역학화병독학응답수평균저우단순AIDS환자.HIV、HBV합병감염자재cART후제12、24、36、48화60개월시,13례환자중유3례재각시간점균표현위HBeAg음전；항-HBe양전솔분별위32.1％(9/28)、50.0％(14/28)、53.6％(15/28)、64.3％(18/28)화71.4％(20/28),양전솔축년증고(x2=10.189,P=0.037); HBV DNA음전솔분별위95.1％(39/41)、82.9％(34/41)、68.3％(28/41)、43.9％(18/41)화43.9％(18/41),음전솔축년하강(x2=29.982,P=0.000);간공능이상솔분별위32.1％(25/78)、51.4％(38/74)、33.8％(22/65)、47.9％(23/48)급6.7％(3/45),각시간점차이유통계학의의(x2=28.053,P=0.000).HIV、HBV합병감염자급단순AIDS환자적병사솔분별위24.4％(19/78)화5.1％(8/156),차이유통계학의의(x2=18.841,P＜0.01),차HIV、HBV합병감염자84.2％사우HBV상관적종말기간병.결론 합병HBV감염가영향cART적원기료효,종말기간병시HIV、HBV합병감염자접수cART후적수요사인.
Objective To investigate the influence of hepatitis B virus (HBV) infection on efficacy of combined antiretroviral therapy (cART) in patients with acquired immunodeficiency syndrome (AIDS).Methods Seventy-eight subjects with human immunodeficiency virus (HIV)/HBV co-infection and 156 subjects with HIV mono-infection were included.CD4+ T cell count,HIV viral load,HBV-markers and liver functions were routinely tested.The differences in survival rate,as well as immunological and virological responses between the two groups (HIV/HBV co-infection group and HIV mono-infection group) during cART were compared.Categorical data were compared by Chisquare test,measurement data were compared by t test,and measurement data with abnormal distribution were compared by Mann-Whitney test.Results At month 42 of cART,HIV RNA levels and CD4+ T cell counts of the two groups were comparable.However,at month 48,54 and 60 of cART,the immunological and virological responses of HIV/HBV co-infection group were less favorable than those of HIV mono-infection group.At each time point of month 12,24,36,48 and 60 of cART,3 out of 13 subjects with HIV/HBV co-infection maintained hepatitis B e antigen (HBeAg)loss; the HBeAg seroconversion rates were 32.1％ (9/28),50.0％ (14/28),53.6％ (15/28),64.3％ (18/28) and 71.4％ (20/28),respectively (x2 =10.189,P=0.037) ; HBV DNA negative rates were 95.1％ (39/41),82.9％ (34/41),68.3％ (28/41),43.9％ (18/41) and 43.9％ (18/41),respectively (x2 =29.982,P=0.000); liver dysfunction rate was 32.1 ％ (25/78),51.4％ (38/74),33.8％ (22/65),47.9％ (23/48) and 6.7％ (3/45),respectively (x2 =28.053,P=0.000).Mortalities in HIV/HBV co-infected and HIV mono-infected individuals were 24.4％ (19/78) and 5.1 ％ (8/156),respectively (x2 =18.841,P＜0.01).Sixteen out of the 19 deaths (84.2 ％) in HIV/ HBV co-infected subjects died of end stage liver diseases.Conclusions HBV co-infection diminishes the long term efficacy of cART.End stage liver diseases are the primary cause of death in HIV/HBV co-infected subjects during cART.