男男性行为者HIV感染队列中新发HBV感染的特点及影响因素

Characteristics and influencing factors of new HBV infection in MSM HIV infection Cohort

目的探讨北京MSM感染HIV过程中合并HBV新发感染情况及影响因素,为制定有效预防乙肝感染策略提供依据。方法以2006年10月至2014年11月,在北京佑安医院MSM高危人群随访队列中发现的HIV急性期感染者为研究对象,观察其在后续随访过程中合并HBV新发感染的情况并进行研究分析。利用SPSS 16.0进行统计分析。结果192例HIV急性期感染者在平均随访1.4年后有14例发生了新发HBV感染,新发HBV感染的患者平均年龄为(35.4±9.1)岁,大于未感染者(32.3±8.7)(P=0.005)。14例中11例为急性自限性HBV感染,3例发展为慢性HBV感染。抗-HBs阴性人群HBV的新发感染率(18.0%)高于抗-HBs阳性的人群(2.3%)(χ^(2)=15.259,P<0.001)。HBV感染后CD4细胞下降速率平均为每个月14个/μL(IQR:6,35.2),高于非HBV感染者6.9个/μL(IQR:5,12)(Z=10.56,P<0.001)。结论HIV感染人群HBV新发感染率及慢性化的比例较高,对HIV阳性MSM应监测乙肝五项并积极接种乙肝疫苗以有效预防HIV感染人群合并新发HBV感染。

Objective To investigate the incidence of HBV infection and its influencing factors among the HIVpositive MSM cohort in Beijing to provide the baseline information for developing effective strategies to HBV control and prevent.Methods We identified the acute HIV-infected individuals who were found in the MSM follow-up cohort of Beijing You’an Hospital from October 2006 to November 2014 as the research subjects.We observed their incidence of HBV and explored the influencing factors.SPSS 16.0 was used to conduct the statistical analysis.Results Of the 192 patients with acute HIV infection who were followed up for an average of 1.4 years,14 cases developed HBV infection.The average age of the new HBV infection patients was 35.4±9.1 years,which was older than those HBV uninfected(32.3±8.7),P=0.005.Of the 14 HBV incidence cases,11 were self-limited and 3(21.4%)developed chronic infections.The incidence of HBV was higher in the anti-HBs-negative population(18.0%)than that in the anti-HBs-positive population(2.3%),χ^(2)=15.259,P<0.001.The average decline in CD4 cells after the HBV infection was 14 cells/μL per month(IQR:6~35.2),which was higher than that among the non-HBV infected population 6.9 cells/μL(5,12),Z=10.56,P<0.001.Conclusions The HBV incidence and the proportion of chronic HBV infection were high in HIV-infected MSM.It is critical to monitor the serum HBV markers among MSM who are at high risk for both HIV and HBV.Further,HIV infected MSM should actively get hepatitis B vaccinated,which can effectively prevent HBV infection.