HIV/HCV共感染者抗逆转录病毒治疗后免疫恢复情况

Immune Recovery after Antiretroviral Therapy in HIV/HCV Co-Infected Patients

由于具有相同的传播途径,人类免疫缺陷病毒(Human immunodeficiency virus,HIV)和丙型肝炎病毒(Hepatitis C virus,HCV)共感染非常普遍,但是关于合并感染的程度,两种病毒之间的相互关系,在艾滋病抗逆转录病毒治疗(Antiretroviral therapy,ART)前后,HCV合并感染对HIV患者免疫细胞恢复的影响仍不明确。为了通过分析CD4^(+)和CD8^(+)T淋巴细胞数的变化,以了解辽宁省HIV/HCV共感染者ART后免疫恢复的情况,本研究从辽宁省艾滋病抗病毒治疗数据库中筛选符合要求的HIV感染者和HIV/HCV共感染者,收集感染者基本人口学资料及HCV抗体检测结果、HIV/HCV共感染途径等资料。采用t检验或卡方检验进行组间比较,采用Kaplan-Meier乘积极限法绘制生存分析函数图。结果显示,本研究共纳入HIV感染者12742人,HIV/HCV共感染者340人。HIV感染者和HIV/HCV共感染者的不同人口学特征均差异显著(P<0.001)。HIV感染和HIV/HCV共感染者ART治疗后CD4^(+)细胞数和CD4^(+)/CD8^(+)比值显著升高(P<0.05),CD8^(+)细胞数比ART前显著下降(P<0.05)。HIV/HCV共感染者随着ART时长,CD4^(+)T淋巴细胞数恢复情况始终显著低于HIV感染者(P<0.05)。生存分析曲线表明,HCV/HIV共感染者从艾滋病诊断开始随着ART的治疗CD4^(+)细胞恢复情况显著低于HIV感染者,Log-Rank检验统计量为4.483(P=0.034)。本研究揭示,HCV感染对ART患者CD4^(+)和CD8^(+)T淋巴细胞的恢复有影响。ART后HIV/HCV共感染者中CD4^(+)T淋巴细胞计数的改善低于HIV单一感染者,并且单一感染患者对ART的反应比合并感染患者更好。因此,建议在启动ART之前,对每个感染HIV的患者进行HCV抗体筛查。

Because of the same transmission route,co-infection of human immunodeficiency virus(HIV)and hepatitis C virus(HCV)is very common.However,regarding the degree of co-infection,the relationship between the two viruses,the impact of HCV co-infection on immune cell recovery in HIV patients before and after anti-retroviral therapy(ART)remains unclear.To study changes in numbers of cluster of differentiation CD4^(+)and CD8^(+)cells and to understand the immune recovery of HIV/HCV co-infected patients after ART in Liaoning Province,China,eligible patients with HIV infection and HIV/HCV co-infection were screened based on data obtained from the Liaoning Provincial Treatment Database.Also,basic demographic data,results of HCV-antibody detection,HIV/HCV co-infection routes,and other data were collected.The Student’s t-test or chi-square test were used for comparison between groups.The Kaplan–Meier multiplied positive limit method was employed to draw a survival graph.Results showed that a total of 12,742 individuals with single HIV infection and 340 patients with HIV/HCV co-infection were included in this study.The different demographic characteristics of HIV-infected and HIV/HCV co-infected patients were significantly different(P<0.001).The number of CD4^(+)cells and the ratio of CD4^(+)cells to CD8^(+)cells was increased significantly(P<0.05)and the number of CD8^(+)cells was decreased significantly(P<0.05)after ART in patients with single HIV infection and co-infection with HIV/HCV.As ART progressed,the recovery of CD4^(+)cells in HIV/HCV co-infected patients was significantly lower than that in HIV-infected patients(P<0.05).Survival analyses showed that significantly fewer patients with HCV/HIV co-infection recovered with ART than those with HIV infection from the beginning of the AIDS diagnosis.The log-rank test statistic was 4.483(P=0.034).The present study suggested that HCV infection had an effect on the recovery of CD4^(+)and CD8^(+)cells in ART patients.Improvement in the CD4^(+)cell count in HIV/HCV co-infected patients after ART was lower than that in HIV-infected patients,and the response to ART was better in single-infected patients than that in co-infected patients.Therefore,HCV antibody screening is recommended for each HIV-infected patient before initiating ART.