艾滋病患者中乙型和丙型肝炎病毒合并感染的临床特征与治疗

Clinical features and treatment of hepatitis B virus and hepatitis C virus co-infection among patients withacquired immune deficiency syndrome

目的分析AIDS患者合并HBV和HCV感染的临床特征，以及含拉米夫定（3Tc）的抗反转录病毒治疗（ART）对肝炎病毒复制的影响。方法2004年至2010年武汉大学中南医院收治合并HBV感染的AIDS患者199例，其中HIV／HBV／HCV三重感染76例，HIV／HBV两重感染123例，对患者常规检测HBsAg和抗一HBc等，分析含3TC的ART前后HBVDNA及HCVRNA变化，并比较终末期肝病发生率在两组的区别。计数资料比较用卡方检验，计量资料比较采用t检验。结果在进行含3TC的ART前，HIV／HBV／HCV组的HBVDNA阳性率为25．0％（19／76），HIV／HBV组为45．5％（56／123），两组间差异有统计学意义（X2=8．429，P=0．004）；HIV／HBV／HCV组HBVDNA为（4．70±1．84）lg拷贝／mL，HIV／HBV组为（5．61±1．88）lg拷贝／mL，两组间差异有统计学意义（t=2．589，P=0．003）。含3TC的ART后，HIV／HBV／HCV组患者HBVDNA阳性率为9．2％（7／76），显著低于治疗前的25．0％（19／76），差异有统计学意义（X2=6．681，P=0．010）；HCVRNA阳性率在治疗后为72．4％（55／76），反较治疗前的56．6％（43／76）上升，差异有统计学意义（X2=4．136，P=0．042）。在平均观察的5．6年间，HIV／HBV／HCV组终末期肝病发生率为每年18．8／1000人年，而HIV／HBV组终末期肝病发生率为每年42．1／1000人年，两组差异有统计学意义（X2=4．459，P=0．035）。结论HBV和HCV合并感染时，两种病毒间可能存在相互影响。选择病例的时机不同可能是影响研究结果的关键因素。

Objective To estimate the clinical features of hepatitis B virus （HBV） and hepatitis C virus （HCV） co-infection among acquired immune deficiency syndrome （AIDS） patients and the interaction of lamivudine （3TC） contained antiretroviral therapy （ART） with hepatitis virus replication. Methods From 2004 to 2010, 199 human immunodeficiency virus （HIV）/HBV co infected patients admitted to Zhongnan Hospital of Wuhan University were enrolled, including 76 cases of HIV/HBV/HCV triple infection and 123 cases of HIV/HBV dual infection. Hepatitis B surface antigen （HBsAg） and hepatitis B core antibody （anti-HBc） were detected routinely. HBV DNA, HCV RNA before and after ART with 3TC and incidence of end-stage-liver-diseases in two groups were compared. Categorical data were analyzed by chi-square test, and measurement data were compared by t test. Results Positive rates of HBV DNA in HIV/HBV and HIV/HBV/HCV coinfection group before treatment were 45. 5% （56/123） and 25. 0% （19/76）, respectively （Z2= 8. 429, P=0. 004）. The levels of HBV DNA in the two groups before treatment were （5. 614-_1.88） lgcopy/mLand （4.70±1.84） lg copy/mL, respectively （t=2.589, P=0.003）. After ART with 3TC, detectable rate of HBV DNA in HIV/HBV/HCV group decreased to 9.2% （7/76）, which was significantly lower than pretreatment （X2 = 6. 681, P = 0. 010）, but serum HCV RNA increased significantly from 56.6% （43/76） pretreatment to 72.4% （55/76） post treatment （X2 =4. 136, P= 0. 042）. The incidence of end-stage liver-diseases in HIV/HBV/HCV co-infected group was significantly lower than that of HIV/HBV dual infection group （18.8 per 1000 person years vs 42. 1 per 1000 person years;）X2- 4. 459, P = 0. 035） during an average of 5.6 years of follow up. Conclusion It is possible that there are interactions between HBV and HCV when the two viruses are co-infected. The timing of patient enrollment might be an impact factor on study results.