南通市HIV合并HBV感染者抗逆转录病毒疗效及影响因素分析
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1.南京医科大学公共卫生学院,江苏 南京 211166 ;2.江苏省疾病预防控制中心,江苏 南京 210009 ;3.南通市疾病预防控制中心,江苏 南通 226000 ;4.南通市第三人民医院(南通大学附属南通第三医院)感染科,江苏 南通 226000

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江苏省十四五流行病学重点学科(ZDXK202250)


Analysis of anti ⁃ retroviral efficacy and influencing factors in HBV/HIV co ⁃ infection in Nantong City
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1.School of Public Health,Nanjing Medical University,Nanjing 211166 ;2.Jiangsu Provincial Center for Disease Control and Prevention,Nanjing 210009 ;3.Nantong Center for Disease Control and Prevention,Nantong 226000 ;4.Department of Infectious Diseases,Nantong Third People’s Hospital(Affiliated Nantong Hospital No.3 of Nantong University),Nantong 226000 ,China

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    摘要:

    目的:了解人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者合并乙型肝炎病毒(hepatitis B virus, HBV)的感染现况和特征,分析HIV/HBV合并感染者抗逆转录病毒治疗(anti-retroviral therapy,ART)效果及影响因素。方法:选取南通市2016年1月—2021年12月新确诊的HIV感染者为调查对象,根据乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg) 检测结果分为HIV单独感染组1 830例和HIV/HBV合并感染组135例,比较两组患者ART前HIV感染特征,分析ART后HIV 病毒学抑制和CD4+ T淋巴细胞变化情况,以评估免疫功能改善情况及影响因素。结果:HIV/HBV合并感染者ART前免疫受损重于HIV单独感染者。接受ART后,HIV单独感染组和HIV/HBV合并感染组的CD4+ T计数总体上均随治疗时间延长呈上升趋势,ART 2年后,两组患者的HIV病毒学抑制率均为90%以上。单因素和多因素Logistic回归分析均显示开始ART的年龄增加、初始CD4+ T < 200个/μL、初始HIV RNA≥4.5[lg(copies/mL)]是影响免疫重建的危险因素。随治疗时间的延长,免疫重建良好率有增加趋势。在ART前合并HBV感染加重HIV感染者的免疫损伤,因而可能影响免疫重建。结论:HBV感染可加重 HIV感染者的免疫损伤,现行HIV/HBV合并感染的ART策略可有效抑制双重感染,有利于HIV/HBV合并感染者的免疫重建。在感染者的干预管理中,ART及疗效监测均存在不足,临床诊疗活动需进一步规范。

    Abstract:

    Objective:To investigate the current situation and characteristics of human immunodeficiency virus(HIV)/hepatitis B virus(HBV)co-infection among HIV-infected individuals,as well as to analyze the effectiveness of anti-retroviral therapy(ART)and its influencing factors for HIV/HBV co-infected patients. Methods:The study selected newly diagnosed HIV patients in Nantong City from January,2016,to December,2021,as the research subjects. Based on the results of hepatitis B surface antigen(HBsAg)testing, the patients were categorized into two groups:an HIV mono-infection group(1 830 cases)and an HIV/HBV co-infection group (135 cases). The study compared the HIV infection characteristics of the two groups before ART,analyzed the virological suppression and CD4 + T lymphocyte count changes after ART therapy,and evaluated the improvement of immune function and its influencing factors. Results:HIV/HBV co-infection led to more severe immune impairment of the patients before ART than those in the HIV mono-infection group. After receiving ART,both the HIV mono-infection group and the HIV/HBV co-infection group showed a gradual increase in CD4 + T count,and the virological suppression rate was over 90% in both groups after two years of ART. Univariate and multivariate logistic regression analyses showed that the increasing age at ART initiation,initial CD4 + T count < 200 cells/μL,and initial HIV RNA ≥4.5[lg(copies/mL)]were risk factors for immune reconstitution. There was also an increasing trend in the rate of favorable immune reconstitution with a prolonged treatment time. Co-infection with HBV exacerbated immune impairment in HIV-infected individuals before ART,which may affect immune reconstitution. Conclusion:HBV infection can worsen immune damage in HIV-infected individuals. The current ART strategy for HIV/HBV co-infection effectively suppresses dual infection and benefits immune reconstitution in HIV/HBV co-infection. However,there are insufficiencies in ART and efficacy monitoring in patient management, highlighting the need for further standardization of clinical diagnosis and treatment activities.

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潘一茹,邱涛,马平,周小毅,丁萍,陈彦君,姜洁,何楚,钱姣,孔泉,邹美银,翟祥军.南通市HIV合并HBV感染者抗逆转录病毒疗效及影响因素分析[J].南京医科大学学报(自然科学版),2024,(7):972-978

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  • 收稿日期:2024-01-18
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  • 在线发布日期: 2024-07-10
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