贵州省383例HIV/HCV共感染者HCV基因分型及临床特征

HCV genotype and clinical features of patients with HIV/HCV coinfection in Guizhou,China:An analysis of 383 cases

目的探讨贵州省383例HIV/HCV共感染者HCV基因型分布特征及共感染对HIV病毒载量、CD4+T淋巴细胞和PLT计数的影响,为HIV合并HCV感染者的个体化治疗提供依据。方法收集2015年3月-2019年12月贵阳市公共卫生救治中心383例HIV/HCV共感染者临床资料,检测HCV基因型、HIV病毒载量、CD4^+T淋巴细胞、PLT计数,并以1068例单纯HIV患者为对照。多组间比较采用Kruskall-Wallis H检验,两组间比较采用Wilcoxon秩和检验,进一步两两比较采用Bonferroni法校正;计数资料组间比较采用卡方检验或Fisher确切概率法。结果4664例HIV感染者中,HCV共感染率为8.21%(383/4664),HCV基因型以6a型(35.51%)、3b型(27.42%)、1b型(21.41%)为主,其次3a(13.32%)、1a(1.31%)、2a(0.52%)、6n(0.26%)、6xa(0.26%)型占比较少。感染途径以静脉药瘾为主(72.59%),其次为性接触(24.80%)。与单纯HIV感染者相比,HIV/HCV共感染者的HIV RNA载量更高、CD4^+T淋巴细胞及PLT计数更低(Z值分别为6.716、11.813、9.192,P值均<0.001)。同时共感染者HCV各基因型中3b型患者的HIV RNA载量最高、CD4^+T淋巴细胞及PLT水平最低,而1a型HIV RNA载量最低、CD4^+T淋巴细胞计数最高(P值均<0.05)。不同临床分期患者中肝硬化代偿期HIV RNA载量最高、慢性丙型肝炎组最低,终末期肝病组CD4+计数最低,慢性丙型肝炎组PLT计数最高(P值均<0.05)。结论贵州HIV/HCV共感染者HCV基因型分布呈多样性,6a、3b、1b型为主要流行株,感染途径以静脉药瘾者居多。共感染对HIV病毒复制、机体免疫状况均有影响,且对HCV基因3b型及肝硬化或终末期肝病的影响更明显。

Objective To investigate the distribution of HCV genotypes in 383 patients with HIV/HCV coinfection in Guizhou,China and the effect of coinfection on HIV viral load,CD4+T lymphocytes,and platelet count(PLT),and to provide a basis for individualized treatment of patients with HIV/HCV coinfection.Methods Related clinical data were collected from 383 patients with HIV/HCV coinfection who were treated in Guiyang Public Health Clinical Center from March 2015 to December 2019,and HCV genotype,HIV viral load,CD4^+T lymphocytes,and PLT were determined.A total of 1068 patients with HIV alone were enrolled as control.The Kruskal-Wallis H test was used for comparison between multiple groups,the Wilcoxon rank-sum test was used for comparison between two groups,and the Bonferroni method was used for further comparison between two groups;the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups.Results Among the 4664 patients with HIV infection,383(8.21%)had HCV coinfection,and the main HCV genotypes were genotype 6a(35.51%),genotype 3b(27.42%),and genotype 1b(21.41%),followed by genotypes 3a(13.32%),1a(1.31%),2a(0.52%),6n(0.26%),and 6xa(0.26%).The most common route of infection was intravenous drug addiction(72.59%),followed by sexual contact(24.80%).Compared with the patients with HIV infection alone,the patients with HIV/HCV coinfection had a significantly higher HIV RNA load and significantly lower CD4^+T lymphocytes and PLT(Z=6.716,11.813,and 9.192,all P<0.05).Among the patients with coinfection,the patients with HCV genotype 3b had the highest HIV RNA load and the lowest CD4+T lymphocytes and PLT,while the patients with HCV genotype 1a had the lowest HIV RNA load and the highest CD4+T lymphocytes(all P<0.05).Among the patients with different clinical stages,the patients with compensated cirrhosis had the highest HIV RNA load,the patients with chronic hepatitis C had the lowest HIV RNA load,the patients with end-stage liver disease had the lowest count of CD4^+T lymphocytes,and the patients with chronic hepatitis C had the highest PLT(all P<0.05).Conclusion The distribution of HCV genotypes is diverse in the patients with HIV/HCV coinfection in Guizhou,and HCV strains with genotypes 6a,3b,and 1b are the main epidemic strains.Intravenous drug addiction is the main route of infection.Coinfection may affect HIV replication and immune status,with a significantly marked effect on HCV genotype 3b and liver cirrhosis or end-stage liver disease.