427例HIV/AIDS患者合并HCV感染的临床分析

Clinical analysis of 427 HIV/AIDS patients complicated with HCV infection

目的探讨广西住院HIV/AIDS患者合并HCV感染现状及临床特点。方法回顾性分析2018—2022年在我院首次住院治疗的13142例HIV/AIDS患者合并HCV的感染率。收集HIV/AIDS合并HCV感染患者(HIV/HCV组)的一般及临床资料,探讨感染途径和直接抗病毒药物(direct-acting antivirals,DAAs)治疗情况;纳入354例同期收治单纯HCV感染者作为对照;分析2组患者重症肝病的发生率和重症肝病致死率。结果13142例HIV/AIDS患者中,427例合并HCV感染,感染率达3.25%。HIV/HCV组感染途径85.71%为异性性传播。与单纯HCV组相比,HIV/HCV组肝衰竭的发生率和重症肝病致死率更高(P均<0.05)。对51例HIV/AIDS合并HCV感染患者进行HCV基因分型:la型占19.61%、lb型占13.73%、2a型占3.92%、3a型占11.76%、3b型占17.65%、6a型占29.41%,6d型占1.96%、6e型占1.96%。427例患者中入院前接受DAAs治疗者仅占1.41%(6/427)。对106例未行DAAs治疗患者分析显示,农民占53.77%,城镇无固定职业者占34.91%;首次在我院检查发现抗-HCV阳性者占64.15%(68/106),院外已确证丙型肝炎多年的37例患者中,不愿意治疗者占83.78%(31/37)。结论广西HIV/AIDS患者合并HCV感染比例高,性传播是合并HCV感染的主要途径,HCV基因型以1、3、6型为主,HIV合并HCV感染易导致肝病重症化,可增加病死率,入院前接受DAAs治疗率很低。因此,对合并HCV感染的HIV/AIDS患者,应加强宣教,提高其依从性,应尽早进行DDAs治疗,改善其预后。

Objective To explore the current situation and clinical characteristics of HCV coinfection in hospitalized HIV/AIDS patients in Guangxi.Method A retrospective analysis was conducted on 13142 HIV/AIDS patients who were hospitalized for the first time in our hospital from 2018 to 2022,to explore the infection rate,infection pathway,and direct-acting antivirals(DAAs)treatment status of HCV comorbidities;We included 354 patients with simple HCV infection admitted during the same period as controls to analyze the incidence and mortality of severe liver disease.Results Among the 13142 HIV/AIDS patients,427 were co-infected with HCV,with an infection rate of 3.25%.Eighty-five point seven one percent of the HIV/HCV group had a history of multiple female partners.Liver failure and fatality incidence were significantly higher than that of the HCV group(P<0.05).Forty-nine cases of HIV/HCV coinfection were genotyped and found to be 1a type 19.61%,lb type 13.73%,2a type 3.92%,3a type 11.76%,3b type 17.65%,6a type 29.41%,6d type 1.96%,and 6e type 1.96%.Only 1.41%of 427 AIDS patients with HCV infection received DAAs before admission.A survey was conducted on the reasons for not receiving treatment among 106 HIV/HCV coinfected cases:53.77%of farmers,34.91%of urban residents without fixed employment;64.15%of patients were found to be positive for hepatitis C during their first hospital examination;Hepatitis C has been discovered outside the hospital for many years,but 83.78%of them are unwilling to receive treatment.Conclusions The proportion of HIV/AIDS combined with HCV infection is high in Guangxi,and sexual transmission is the leading cause of combined HCV infection.HCV genotypes are mainly types 1,3,and 6.HIV and HCV coinfection can easily lead to severe liver disease and increased mortality.The DAAs treatment rate before admission is low.Therefore,in case of combined HCV infection,education should be strengthened,compliance should be improved,and antiviral treatment should be carried out as soon as possible.