HIV合并HBV/HCV病人抗病毒治疗5年疗效及生存状况分析

Efficacy and survival status of HIV patients with HBV/HCV infection for five years of ART

目的了解艾滋病病毒(HIV)合并乙型肝炎病毒(HBV)或丙型肝炎病毒(HCV)病人抗病毒治疗(ART)5年疗效差异及生存状况,为临床提供参考依据。方法选取昆明市第三人民医院2010年1月至2013年6月开始ART的病人,分为HIV/HBV组、HIV/HCV组、HIV/HBV/HCV组和单纯HIV组。采用COX回归分析、χ^2检验、H检验和M检验分析病人治疗5年的生存状况以及各组间病毒学和免疫学疗效的差异。结果治疗时年龄[比值比(OR)=1.034,P=0.001]、合并HBV和/或HCV感染(OR=3.361,P<0.001)是死亡危险因素;治疗前CD4+T淋巴细胞(简称CD4细胞)计数高(OR=0.998,P=0.024)是死亡的保护因素。治疗期间四组病人之间病毒学疗效差异无统计学意义(P>0.05)。随着治疗时间的延长,四组病人CD4细胞水平均有提高(四组P均<0.001)。同一治疗时间点四组病人间的CD4细胞水平只有治疗第1年、第2年有差异;治疗前、治疗3、4和5年四组间差异均无统计学意义。结论HBV、HCV共感染不影响ART的病毒学和免疫学疗效。提倡早治疗,同时加强HBV、HCV的筛查及治疗。

Objective To understand the efficacy and survival status of HIV patients with HBV/HCV for five years of ART so as to provide references for clinical practice.Methods HIV patients with HBV or HCV who started ART in the third people’s hospital of Kunming from Jan 2010 to Jun 2013 were divided into HIV/HBV group,HIV/HCV group,HIV/HBV/HCV group and only HIV group.COX regression analysis,Chi-square test,H test and M test were used to evaluate the survival status of the patients,and virology and immunology were compared between the four groups of patients.Results Treatment age(OR=1.034,P=0.001),patients with HBV and/or HCV(OR=3.361,P<0.001)were risk factors for death.The CD4 count before ART was a protective factor for death(OR=0.998,P=0.024).There was no statistically significant difference in immunological and virological efficacy between the four groups during the treatment.Conclusion HBV and/or HCV co-infection does not affect the efficacy of ART in virology and immunology.It is necessary to promote early treatment,and strengthen HBV or HCV screening and treatment.