云南省红河州静脉吸毒人群中HIV感染者的HCV共感染调查

Investigation of HCV/HIV co-infection in injecting drug users in Honghe prefecture,Yunnan province

目的调查云南省红河州静脉吸毒人群中艾滋病病毒(HIV)感染者的丙型肝炎病毒(HCV)合并感染率、HCV感染状况。方法采集600份红河州静脉吸毒人群中HIV感染者的血浆样本,用HCV抗体酶联免疫吸附试验在基层实验室初筛、在艾滋病参比实验室复检,初复检至少有一个为反应性结果的样本做核酸检测。结果基层实验室和艾滋病参比实验室的初复检一致率为99.3%(596/600)。HCV合并感染率53.6%(319/595),多因素分析:年龄30~40和40~50岁、退休或失业及其他职业是危险因素,比值比(OR)值分别为5.970、7.709、10.821、4.151;年龄≥60、女性、已婚(含分居)、大学及以上的学历是保护因素,OR值分别为0.036、0.224、0.474、0.082。281份核酸阳性,其中57.65%病毒载量大于10~6IU/mL。HCV病毒载量的分布在未服用和服用抗反转录病毒药物间差异有统计学意义(P<0.05)。319份HCV合并感染样本中,11.91%核酸清除,多因素分析:服用抗反转录病毒药物是核酸清除的保护因素,OR值为0.295。结论云南省红河州静脉吸毒人群中HIV/HCV合并感染严重,中年男性、单身或离异等、低学历者、退休人员或失业者是合并感染的独立影响因素;合并感染者的HCV病毒载量较高,但服用抗反转录病毒药物可降低HCV病毒载量,使HCV核酸清除。

Objective To investigate the infection rate of HCV co-infected with HIV among injecting drug users in Honghe prefecture,Yunnan province.Methods 600 plasma samples of HIV patients with injecting drug abuse in Honghe were screened in grassroots laboratory and national AIDS reference laboratory with HCV antibody enzyme-linked immune-sorbent assay(ELISA).Recombination immune-blot assay was made when the results of two ELISA were inconsistent or S/CO value of the second was ranging from 1 to 20.Nucleic acid test was made if at least one of two ELISA was reactive.Results The agreement rate of results between the grassroots laboratory and national AIDS reference laboratory was 99.3%(596/600).The rate of HIV/HCV co-infection was 53.6%(319/595),of which risk factors included 30-40 years old(OR:5.970),40-50 years old(OR:7.709),retirement or unemployment(OR:10.821)and other occupations(OR:4.151);and protective factors were age≥60 years(OR:0.036),female(OR:0.224),the married(including separated)(OR:0.474)and college degree or above(OR:0.082).281 nucleic acid samples were positive,of which 162 had beyond 106 IU/ml of viral loads.The distribution of HCV viral load was statistically different when the antiretroviral drugs were taken or not.Of 319 HIV/HCV co-infection,11.91% were free of nucleic acid.Multivariate analysis showed that administration of antiretroviral drugs was a protective factor for nucleic acid clearance(OR:0.295).Conclusion HIV/HCV infection is severe among injecting drug users in Honghe,and middle-aged males,the singles or divorced,low-educated,retirees or unemployed may promote the co-infection.HCV viral load is higher in co-infected patients.However,antiretroviral drugs can reduce HCV viral load and clear HCV nucleic acids.