人类免疫缺陷病毒感染者混合感染丙型和乙型肝炎病毒后对高效抗逆转录病毒治疗疗效的影响

The influence of human immunodeficiency virus co-infection with hepatitis C virus and hepatitis B virus on the efficacy of high active anti-retroviral therapy

目的 观察HIV感染者合并HCV和HBV感染后对高效抗逆转录病毒治疗（HAART）疗效的影响.方法 对某地区HIV、HCV共感染患者166例（HIV＋HCV组）,HIV、HCV和HBV混合感染患者23例（H1V＋HCV＋HBV组）及单纯HIV感染者178例,给予1年的HAART治疗,观察3组患者病毒学反应、免疫学反应和肝功能动态变化.以流式细胞仪检测外周血CD4＋T淋巴细胞;实时PCR定量检测HCV、HIV和HBV病毒载量.结果 单纯HIV感染组、HIV＋HCV＋HBV组和HIV＋HCV组经HAART 1年后,HIV病毒载量分别由治疗前（6.78±1.08）、（6.23±1.34）、（6.54±1.23）lg拷贝/ml下降至（0.53±0.15）、（0.67±0.16）、（0.43±0.11）lg拷贝/ml（P值均＜0.001）.CD4＋T淋巴细胞计数分别由治疗前的（197±127）、（184±113）、（213±143）个/μl上升至（382±74）、（383±70）、（378±76）个/μl（P值均＜0.001）.3组之间各时间点CD4＋T淋巴细胞、HIV病毒载量差异无统计学意义.3组患者ALT、AST、总胆红素治疗前后无显著变化,相同时间点组间比较差异无统计学意义.HAART前后,HCV病毒载量差异无统计学意义.结论 HIV感染者混合感染HBV和（或）HCV,不影响HAART的疗效;HAART对HCV复制无抑制作用.

Objective To evaluate the impact of HIV co-infection with HCV or HBV on the efficacy of highly active anti-retroviral therapy （HARRT）. Methods The patients were divided into three groups： HIV ＋ HBV ＋ HCV co-infection group （ 23 patients）, HIV ＋ HCV co-infection group （ 166 patients）, and HIV-only group （178 patients）. HIV RNA, HCV RNA or HBV DNA were detected by real time PCR before treatment and 1,3,6,9 and 12 monthes after treatment, meanwhile the counts of CD4＋ T lymphocyte and liver function including ALT, AST and TBil were tested. Results During one-year HAART, HIV RNA of HIV-only group, HIV ＋ HBV ＋ HCV co-infection group and HIV ＋ HCV co-infection group decreased significantly from （6.78 ± 1.08）, （6.23 ± 1.34）, （6.54 ± 1.23） lg copies/ml to （0.53 ±0.15）, （0.67 ±0.16）,（0.43 ±0.11 ） lg copies/ml respectively （P〈.001 ）. And CD4＋ T lymphocyte counts of the three groups elevated significantly from （ 197 ± 127）, （184 ± 113）, （213 ± 143） cells/μl to （382 ±74）, （383 ±70）,（378 ±76） cells/μl respectively （P 〈0.001 ）. However there were no differences among the three groups in HIV RNA and CD4＋ T lymphocyte counts. There were no differences in liver functions including ALT,AST and TBil among the three groups. Conclusiom HIV co-infected with HBV and/or HCV does not impact on the efficacy of HAART. What more, HAART does not impact HCV replication.