宁波市中心城区≥15岁人类免疫缺陷病毒阳性人群乙型肝炎病毒感染发生风险影响因素的COX比例风险模型分析

Factors influencing hepatitis B virus infection risk among human immunodeficiency virus positive individuals in central urban areas of Ningbo city,a COX proportional risk model

目的分析人类免疫缺陷病毒(Human immunodeficiency virus,HIV)阳性人群乙型肝炎病毒(Hepatitis B virus,HBV)感染发生风险及其影响因素。方法通过国家艾滋病综合防治信息平台选择宁波市某医院2006-2022年确诊和管理的≥15岁且HBV血清标志物检测排除HBV感染的HIV阳性患者,随访至2023年6月31日,计算HBV感染发生率并采用多因素COX比例风险模型分析发生HBV感染的影响因素,计算风险比(Hazard ratio,HR)及其95%CI。结果共纳入362例研究对象,平均确诊年龄为33.09±12.27岁,平均观察时间为5.02±3.71人年;观察期内发生HBV感染78例(21.55%),发生率为4.29(95%CI:3.40-5.32)/100人年。多因素COX比例风险模型分析显示,年龄30-49岁和≥50岁、CD4^(+)与CD8^(+)T细胞比值<0.3、有梅毒感染史者HBV感染发生风险高[HR(95%CI):3.83(2.07-7.07)、5.46(2.71-11.02)、2.97(1.73-5.10)、2.27(1.39-3.70)],有乙型肝炎疫苗(Hepatitis B vaccine,HepB)接种史者HBV感染发生风险低[HR(95%CI):0.37(0.19-0.72)]。结论HIV阳性人群特别是确诊年龄大、CD4^(+)与CD8^(+)T细胞比值低、有梅毒感染史和无HepB接种史者HBV感染发生风险较高。建议加强HIV阳性人群HepB接种或抗HBV治疗。

Objective To analyze the risk of hepatitis B virus(HBV)infection and factors influencing risk among human immunodeficiency virus(HIV)positive individuals.Methods We obtained data on HIV-positive individuals over 15 years of age from the National HIV/AIDS Prevention and Control Information Platform.All subjects were diagnosed and managed during 2006-2022 in a hospital of Ningbo city;all had initially tested negative for HBV infection based on screening for serum HBV markers.We followed subjects until 31 June 2023 to determine the incidence of HBV infection.We used a multivariate COX proportional risk model to identify factors influencing HBV infection and calculated hazard ratios(HR)and 95%confidence intervals(CI).Results A total of 362 subjects were included;the average age was 33.09±12.27 years and the average length of follow-up was 5.02±3.71 person-years;78 subjects(21.55%)became infected with HBV,yielding an incidence of 4.29(95%CI:3.40-5.32)per 100 person-years.Multivariate COX proportional risk model analysis showed that the incidence of HBV infection was highest among subjects who were 30-49 or≥50 years old,whose baseline ratios of CD4^(+)to CD8^(+)T cell were less than 0.3,and who had a history of syphilis[HR(95%CI):3.83(2.07-7.07),5.46(2.71-11.02),2.97(1.73-5.10),and 2.27(1.39-3.70)];the incidence was lowest among subjects who had received hepatitis B vaccine(HepB)[HR(95%CI):0.37(0.19-0.72)].Conclusions HIV-positive individuals,particularly at older age,with a low ratio of CD4^(+)to CD8^(+)T cell,a history of syphilis,or who had not received HepB vaccination had a high risk of HBV infection.We recommend HepB vaccination or anti-HBV therapy for HIV-positive individuals.