经血液（非静脉吸毒者）和性途径传播的HIV感染者合并HBV和HCV感染的现状

Study on the prevalence of hepatitis B virus and hepatitis C virus in human immunodeficiency virus positive patients infected by blood （with exception of intravenous drug users） and sexual transmission routes

目的探讨我国经血液（非静脉吸毒者）和性途径传播的HIV感染者合并乙型肝炎和丙型肝炎的状况。方法回顾性分析2005年l至9月在全国13个研究中心就诊的362例HIV／AIDS患者（静脉吸毒者除外），应用酶联免疫试剂盒分别测定其HBsAg、抗HBs、HBeAg、抗-HBe、抗-HBc和抗HCV。采用t检验和χ^2检验分别对计量和计数结果进行统计学分析。结果315例检测血HBV和HCV的患者中，HBsAg阳性14例，占4．4％；抗HCV阳性158例，占50．2％，抗-HCV阴性157例，占49．8％；HIV、HBV、HCV共感染2例，占0．6％。抗-HCV阳性组中经血液和性传播的比例分别占92％和4％，以血液传播为主；抗-HCV阴性组中经血液和性传播的比例分别占11％和66％，以性传播为主。抗-HCV阳性组的HIV确诊时间、CD4^＋T淋巴细胞绝对计数、ALT和AST均高于抗-HCV阴性组。两组患者的HBV标志物表达也存在差异，其中抗-HCV阳性组中HBsAg阳性2例，占1．3％，抗-HCV阴性组中HBsAg阳性12例，占7．6％，两组比较差异有统计学意义（χ^2=7．542，P〈0．01）。10例HBsAg阳性者进行HBVDNA检测，其中4例阳性，抗-HCV均为阴性。57例抗-HCV阳性患者进行HCVRNA检测，阳性者占63．2％。结论我国输血和性传播途径的HIV感染合并HBV或HCV感染，以合并HCV感染为主，并多见于经输血感染者。合并HCV感染可加重H1V患者的肝脏损伤，同时也可能存在干扰HBV复制的情况。

Objective To investigate the prevalence of hepatitis B virus （HBV） and hepatitis C virus （HCV） in human immunodeficiency virus （HIV）positive patients infected by blood （with exception of intravenous drug users） and sexual transmission routes in China. Methods Three hundred and sixty-two cases of HIV positive patients from 13 acquired immune deficiency syndrome （AIDS） centers of China （those intravenous drug users were excluded） were analyzed retrospectively. The serological markers of HBV infection including HBsAg, anti HBs, HBeAg, anti-HBe, anti-HBc and anti-HCV antibodies were detected by the chemiluminescence immunoassay（CMIA） or enzyme linked immunosorbent assay （ELISA）. Numeration and measurement data were analyzed using chi square test and t test, respectively. Results Both HBV markers and HCV antibody were detected in 315 HIV postitive patients. Among them, fourteen cases were HBsAg positive, with the percentage of 4.4%. One hundred and fifty-eight cases （50. 2%） were anti HCV antibody postive and 157 cases （49.8%） were negative. Only 2 cases （0.6%） were HIV, HBV, HCV co-infection. In the anti-HCV positive group, the percentage of blood and sexual transmission were 92 % and 4%, respectively, with a predominant blood transmission; while in the anti-HCV negative group, the percentage of blood and sexual transmission were 11% and 66% respectively, dominating with sexual transmission. The duration of HIV infection, CD4^＋ T cell absolute numbers, alanine aminotransferase （ALT） and aspartate aminotransferase （AST） levels were all higher in the anti-HCV positive group than those in the anti-HCV negative group. Meanwhile, there were 2 cases （1.3 %） of HBsAg positive in the anti- HCV positive group while 12 cases （7.6%） in the anti HCV negative group, with a statistically significant difference （χ^2= 7. 542, P〈0.01）. HBV DNA detection was performed in 10 HBsAg positive patients, four of them were HBV DNA positive but all were anti-HCV negative. Fifty-seven patients with anti-HCV positive received HCV RNA detection and 63. 2% of them were positive. Conclusions HBV and HCV co-infection exists in HIV-infected Chinese patients, predominantly with HCV co-infection and by blood transmission. HCV infection may aggravate the liver injury of HIV infection and, at the same time, may have some mechanisms to interfere HBV replication.