Background: Liver biopsy is an invasive technique with associated major complications. There is no information on the validity of five non-invasive indexes based on routinely available parameters, estimated and valida...Background: Liver biopsy is an invasive technique with associated major complications. There is no information on the validity of five non-invasive indexes based on routinely available parameters, estimated and validated in hepatitis C virus (HCV) monoinfected patients, in human immuno-deficiency virus (HIV)/HCV coinfected patients. Aim: To validate these predictive models of liver fibrosis in HIV/HCV coinfected patients. Patients: A total of 357 (90% ) of 398 patients from five hospitals were investigated, who underwent liver biopsy and who had complete data to validate all of the models considered. Methods: The predictive accuracy of the indexes was tested by measuring areas under the receiver operating characteristic curves. Diagnostic accuracy was calculated by estimating sensitivity, specificity, and positive (PPV) and negative (NPV)- predictive values. Results: The models performed better when liver biopsies ≥ 15 mm were used as reference. In this setting, the Forns and Wai indexes, models aimed at discriminating significant fibrosis, showed PPV of 94% and 87% , respectively. Using these models, 27- 34% of patients could benefit from exclusion of liver biopsy. If both models were applied sequentially, 41% of liver biopsies could be spared. The indexes aimed at predicting cirrhosis achieved NPV of up to 100% . However, they showed very low PPV. Conclusions: The diagnostic accuracy of thesemodelswas lower in HIV/HCV coinfected patients than in the validation studies performed in HCV monoinfected patients. However, simple fibrosis tests may render liver biopsy unnecessary in deciding anti-HCV treatment in over one third of patients with HIV infection and chronic hepatitis C.展开更多
Persons chronically infected with hepatitisCvirus (HCV), some of whom may be coinfected with HIV and human T-lymphotropic virus type II (HTLV-II), are at high risk for end-stage liver disease (ESLD). We evaluated whet...Persons chronically infected with hepatitisCvirus (HCV), some of whom may be coinfected with HIV and human T-lymphotropic virus type II (HTLV-II), are at high risk for end-stage liver disease (ESLD). We evaluated whether ESLD death was associated with premorbid HCV RNA level or specific HCV protein antibodies among persons with or without HIV/HTLVII coinfection in a cohort of 6,570 injection drug users who enrolled in 9 US cities between 1987 and 1991. We compared 84 ESLD descendents and 305 randomly selected cohort participants with detectable HCV RNA, stratified by sex, race, HIV, and HTLV-II strata. Relative hazard (RH) of ESLD death was derived from the proportional hazard model. Risk of ESLD death was unrelated to the intensity of antibodies against the HCV c- 22(p), c- 33(p), c- 100(p), and NS5 proteins, individually or combined, but it increased with HCV RNA level (RHadj = 2.26 per log10 IU/mL, 95% CI: 1.45- 5.92). The association between HCV RNA level and ESLD death remained significant after adjustment for alcohol consumption (RHadj = 2.57 per log10 IU/mL, 95% CI: 1.50- 8.10). Deaths from AIDS (n = 45) and other causes (n = 43) were unrelated to HCV RNA (RHadj = 1.14 and 1.29 per log10 IU/mL, respectively). HIV infection was not associated with ESLD risk in multivariate analyses adjusted for HCV RNA. Men had an increased risk of ESLD death in unadjusted analyses (RH = 1.92, 95% CI: 1.15- 3.56) but not in multivariate analysis (RHadj = 0.98, 95% CI: 0.48- 2.88). Non-black patients were at increased risk for ESLD death (RHadj = 2.76, 95% CI: 1.49- 10.09). In conclusion, HCV RNA level is a predictor of ESLD death among persons with chronic HCV infection.展开更多
丙型肝炎是由丙型肝炎病毒(hepatitis C virus,HCV)感染而引起的病毒性肝炎,目前感染率高、慢性化程度严重、临床治疗效果不理想、治疗花费巨大,迫切需要研发有效的疫苗进行防治。本文将影响疫苗研发的关键问题,抗病毒分子免疫应答在控...丙型肝炎是由丙型肝炎病毒(hepatitis C virus,HCV)感染而引起的病毒性肝炎,目前感染率高、慢性化程度严重、临床治疗效果不理想、治疗花费巨大,迫切需要研发有效的疫苗进行防治。本文将影响疫苗研发的关键问题,抗病毒分子免疫应答在控制HCV感染过程中的作用和HCV感染模型,与丙肝疫苗研究相融合,对当前丙肝疫苗的最新研究策略和进展作一综述。展开更多
文摘Background: Liver biopsy is an invasive technique with associated major complications. There is no information on the validity of five non-invasive indexes based on routinely available parameters, estimated and validated in hepatitis C virus (HCV) monoinfected patients, in human immuno-deficiency virus (HIV)/HCV coinfected patients. Aim: To validate these predictive models of liver fibrosis in HIV/HCV coinfected patients. Patients: A total of 357 (90% ) of 398 patients from five hospitals were investigated, who underwent liver biopsy and who had complete data to validate all of the models considered. Methods: The predictive accuracy of the indexes was tested by measuring areas under the receiver operating characteristic curves. Diagnostic accuracy was calculated by estimating sensitivity, specificity, and positive (PPV) and negative (NPV)- predictive values. Results: The models performed better when liver biopsies ≥ 15 mm were used as reference. In this setting, the Forns and Wai indexes, models aimed at discriminating significant fibrosis, showed PPV of 94% and 87% , respectively. Using these models, 27- 34% of patients could benefit from exclusion of liver biopsy. If both models were applied sequentially, 41% of liver biopsies could be spared. The indexes aimed at predicting cirrhosis achieved NPV of up to 100% . However, they showed very low PPV. Conclusions: The diagnostic accuracy of thesemodelswas lower in HIV/HCV coinfected patients than in the validation studies performed in HCV monoinfected patients. However, simple fibrosis tests may render liver biopsy unnecessary in deciding anti-HCV treatment in over one third of patients with HIV infection and chronic hepatitis C.
文摘Persons chronically infected with hepatitisCvirus (HCV), some of whom may be coinfected with HIV and human T-lymphotropic virus type II (HTLV-II), are at high risk for end-stage liver disease (ESLD). We evaluated whether ESLD death was associated with premorbid HCV RNA level or specific HCV protein antibodies among persons with or without HIV/HTLVII coinfection in a cohort of 6,570 injection drug users who enrolled in 9 US cities between 1987 and 1991. We compared 84 ESLD descendents and 305 randomly selected cohort participants with detectable HCV RNA, stratified by sex, race, HIV, and HTLV-II strata. Relative hazard (RH) of ESLD death was derived from the proportional hazard model. Risk of ESLD death was unrelated to the intensity of antibodies against the HCV c- 22(p), c- 33(p), c- 100(p), and NS5 proteins, individually or combined, but it increased with HCV RNA level (RHadj = 2.26 per log10 IU/mL, 95% CI: 1.45- 5.92). The association between HCV RNA level and ESLD death remained significant after adjustment for alcohol consumption (RHadj = 2.57 per log10 IU/mL, 95% CI: 1.50- 8.10). Deaths from AIDS (n = 45) and other causes (n = 43) were unrelated to HCV RNA (RHadj = 1.14 and 1.29 per log10 IU/mL, respectively). HIV infection was not associated with ESLD risk in multivariate analyses adjusted for HCV RNA. Men had an increased risk of ESLD death in unadjusted analyses (RH = 1.92, 95% CI: 1.15- 3.56) but not in multivariate analysis (RHadj = 0.98, 95% CI: 0.48- 2.88). Non-black patients were at increased risk for ESLD death (RHadj = 2.76, 95% CI: 1.49- 10.09). In conclusion, HCV RNA level is a predictor of ESLD death among persons with chronic HCV infection.
文摘丙型肝炎是由丙型肝炎病毒(hepatitis C virus,HCV)感染而引起的病毒性肝炎,目前感染率高、慢性化程度严重、临床治疗效果不理想、治疗花费巨大,迫切需要研发有效的疫苗进行防治。本文将影响疫苗研发的关键问题,抗病毒分子免疫应答在控制HCV感染过程中的作用和HCV感染模型,与丙肝疫苗研究相融合,对当前丙肝疫苗的最新研究策略和进展作一综述。
