不同抗HIV治疗方案对HCV与HIV合并感染者丙型肝炎疾病进展的影响

孙洪清; 黄琴; 沈芳; 邬敏; 周晓明; 蔡卫平; 胡芸文

doi:10.3969/j.issn.1001-5256.2013.11.009

不同抗HIV治疗方案对HCV与HIV合并感染者丙型肝炎疾病进展的影响

DOI: 10.3969/j.issn.1001-5256.2013.11.009

1. 上海市公共卫生临床中心感染科
2. 上海市公共卫生临床中心检验科
3. 复旦大学上海医学院流行病学教研室
4. 广州市第八人民医院感染科

详细信息

中图分类号: R512.91
计量
- 文章访问数: 2999
- HTML全文浏览量: 24
- PDF下载量: 607
- 被引次数: 0
出版历程
- 收稿日期: 2012-11-28
- 出版日期: 2013-11-20

Effects of different anti- HIV therapies on progression of hepatitis C in HCV / HIV- coinfected patients

Department of Infectious Diseases, Shanghai Public Health Clinical Center

摘要

摘要: 目的探讨以蛋白酶抑制剂（PIs）或非核苷类反转录酶抑制剂（NNRTIs）为主方案治疗HCV/HIV合并感染者,对患者丙型肝炎疾病进展的影响。方法收集初次就诊的273例HCV/HIV合并感染者为研究对象。分别用PIs（PIs组,135例）或NNRTIs（NNRTIs组,138例）为主的方案治疗1年。实验室检查治疗前、后HCV RNA、AST、ALT、TBil、白蛋白（Alb）、层粘连蛋白（LN）、甘胆酸（CG）、Ⅲ型前胶原（PCⅢ）、Ⅳ型胶原（CⅣ）、凝血酶原活动度（PTA）、胆碱酯酶（ChE）等指标。计量资料经Kolmogorov-Smirnov检验,非正态分布数据采用Mann Whitney U检验。结果治疗后NNRTIs组PTA、ChE、TBil、Alb、ALT、AST、CG、LN显著高于PIs组。PTA分别是77%（67%,109%）和68%（56%,91%）;ChE分别是6717.00（5951.00,7622.00）和5862.00（4392.00,8539.25）U/L;TBil分别是10.95（8.10,14.32）和8.60（8.00,9.50）μmol/L;Alb分别...
- 肝炎,丙型,慢性 /
- 肝炎病毒属 /
- HIV /
- 蛋白酶抑制药 /
- 抗逆转录病毒治疗,高效
Abstract: Objective To investigate the effect of protease inhibitors ( PIs) - or non- nucleoside reverse transcriptase inhibitors ( NNRTIs) - based therapy on the progression of hepatitis C in patients with hepatitis C virus ( HCV) / human immunodeficiency virus ( HIV) coinfection. Methods A total of 273 patients initially diagnosed with HCV / HIV coinfection were enrolled and divided into PIs group ( n = 135) and NNRTIs group ( n = 138) to receive PIs- based therapy and NNRTIs- based therapy, respectively, for one year. Laboratory indices, such as HCV RNA, aspartate aminotransferase ( AST) , alanine aminotransferase ( ALT) , total bilirubin ( TBil) , albumin ( Alb) , laminin ( LN) , cholyglycine ( CG) , type III procollagen ( PCIII) , type IV collagen ( CIV) , prothrombin activity ( PTA) , and cholinesterase ( CHE) , were quantified before and after treatment. The obtained data were analyzed using SPSS 11. 5 software; enumeration data were analyzed using the Kolmogorov- Smirnov test, and non- normal data were analyzed using the Mann- Whitney U test. Results After the end of treatment, PTA, CHE, TBil, Alb, ALT, AST, CG, and LN levels were significantly higher in NNRTIs group than in PIs [PTA: 77% ( 67%-109%) vs 68% ( 56%-91%) ; CHE: 6717. 00 U/L ( 5951. 00-7622. 00 U/L) vs 5862. 00 U/L ( 4392. 00- 8539. 25 U/L) ;TBil: 10. 95 μmol / L ( 8. 10- 14. 32 μmol / L) vs 8. 60 μmol / L ( 8. 00- 9. 50 μmol / L) ; Alb: 43. 90 mmol / L ( 39. 65- 48. 20 mmol / L) vs 38. 90 mmol / L ( 36. 00- 45. 00 mmol / L) ; ALT: 52. 50 U / L ( 30. 00- 93. 50 U / L) vs 36. 20 U / L ( 30. 30- 40. 40 U / L) ; AST: 49. 00U /L ( 33. 00- 80. 00 U / L) vs 31. 30 U / L ( 29. 70- 38. 70 U / L) ; CG: 16. 78 μg / ml ( 3. 26- 29. 32 μg / ml) vs 3. 26 μg / ml ( 1. 02-6. 88 μg / ml) ; LN: 34. 40 ng / ml ( 16. 71- 46. 54 ng / ml) vs 34. 05 ng / ml ( 33. 42- 64. 33 ng / ml) ; P < 0. 01 or P < 0. 05]. Conclusion NNRTIs- based therapy can accelerate the progression of hepatitis C in HCV / HIV- coinfected patients.
- hepatitis C, chronic /
- hepacivirus /
- HIV /
- protease inhibitors /
- antiretroviral therapy, highly active

HTML全文

参考文献(1)

[1]MACíAS J, BERENGUER J, JAPN MA, et al.Fast fibrosis progression between repeated liver biopsies in patients coinfected with human immunodeficiency virus/hepatitis C virus[J].Hepatology, 2009, 50 (4) :1056-1063.[2]GRüNHAGE F, WASMUTH JC, HERKENRATH S, et al.Transient elastography discloses identical distribution of liver fibrosis in chronic hepatitis C between HIV-negative and HIV-positive patients on HAART[J].Eur J Med Res, 2010, 15 (4) :139-144.[3]AIDS Study Group, Chinese Society of Infectious Diseases, Chinese Medical Association.HIV/AIDS management guidelines (2011) [J].Chin J Infect Dis, 2011, 29 (10) :629-640. (in Chinese) 中华医学会感染病分会艾滋病学组.艾滋病诊疗指南 (2011版) [J].中华传染病杂志, 2011, 29 (10) :629-640.[4]Chinese Society of Hepatology, Chinese Society of Infectious Diseases and Parasitology, Chinese Medical Association.The guideline of prevention and treatment for hepatitis C[J].J Clin Hepatol, 2004, 20 (4) :197-203. (in chinese) 中华医学会肝病学分会, 中华医学会传染病与寄生虫病学分会.丙型肝炎防治指南[J].临床肝胆病杂志, 2004, 20 (4) :197-203.[5]LI VECCHI V, SORESI M, COLOMBA C, et al.Transient elastography:a non-invasive tool for assessing liver fibrosis in HCV/HIV patients[J].World J Gastroenterol, 2010, 16 (41) :5225-5232.[6]Al-MOHRI H, MURPHY T, LU Y, et al.Evaluating liver fibrosis progression and the impact of antiretroviral therapy in HIV and hepatitis C coinfection using a noninvasive marker[J].J Acquir Immune Defic Syndr, 2007, 44 (4) :463-469.[7]MORENO A, CERVERA C, FORTU'N J, et al.Epidemiology and outcome of infections in HIV/HCV-coinfected liver transplant recipients:A FIPSE/GESIDA prospective cohort study[J].Liver Transpl, 2012, 18 (1) :70-81.[8]LOKO MA, BANI-SADR F, WINNOCK M, et al.Impact of HAART exposure and associated lipodystrophy on advanced liver fibrosis in HCV/HIV-coinfected patients[J].J Viral Hepat, 2011, 18 (7) :e307-e314.[9]BLACKARD JT, SHERMAN KE.HCV/HIV co-infection:time to re-evaluate the role of HIV in the liver?[J].J Viral Hepat, 2008, 15 (5) :323-330.[10]SINGAL AK.Anand BSManagement of hepatitis C virus infection in HCV/HIV co-infected patients:clinical review[J].World J Gastroenterol, 2009, 15 (30) :3713-3724.[11]STERLING RK, WEGELIN JA, SMITH PG, et al.Similar progression of fibrosis between HCV/HIV-infected and HCV-infected patients:Analysis of paired liver biopsy samples[J].Clin Gastroenterol Hepatol, 2010, 8 (12) :1070-1076.[12]CONNOY A, TURNER J, NU'EZ M.Levels of serum markers of liver inflammation and fibrosis in patients with chronic hepatitis C virus infection according to HIV status and antiretroviral use[J].AIDS Res Hum Retroviruses, 2011, 27 (7) :719-725.[13]LUTZ P, WASMUTH JC, NISCHALKE HD, et al.Progression of liver fibrosis in HCV/HIV genotype 1 co-infected patients is related to the T allele of the rs12979860 polymorphism of the IL28B gene[J].Eur J Med Res, 2011, 16 (8) :335-341.[14]de BONA A, GALLI L, GALLOTTA G, et al.Rate of cirrhosis progression reduced in HCV/HIV co-infected non-responders to anti-HCV therapy[J].New Microbiol, 2007, 30 (3) :259-264.[15]INGILIZ P, VALANTIN MA, PREZIOSI P, et al.Influence of interferon-based therapy on liver fibrosis progression in HCV/HIV coinfected patients:A retrospective repeated liver biopsy analysis[J].J Hepatol, 2012, 56 (1) :49-54.[16]JANG JY, SHAO RX, LIN W, et al.HIV infection increases HCV-induced hepatocyte apoptosis[J].J Hepatol, 2011, 54 (4) :612-620.[17]TIEN PC, KOTLER DP, OVERTON ET, et al.Study of Fat Redistribution and Metabolic Change in HIV Infection Investigators.Regional adipose tissue and elevations in serum aminotransferases in HIV-infected individuals[J].J Acquir Immune Defic Syndr, 2008, 48 (2) :1691-1676.[18]KELLEHER TB, MEHTA SH, BHASKAR R, et al.Prediction of hepatic fibrosis in HCV/HIV co-infected patients using serum fibrosis markers:the SHASTA index[J].J Hepatol, 2005, 43 (1) :78-84.[19]BARREIRO P, PINEDA JA, RALLAN N, et al.Influence of interleukin-28B single-nucleotide polymorphisms on progression to liver cirrhosis in human immunodeficiency virus-hepatitis C virus-coinfected patients receiving antiretroviral therapy[J].J Infect Dis, 2011, 203 (11) :1629-1636.[20]GARCíA-lVAREZ M, GUZMAN-FULGENCIO M, BERENGUER J, et al.European mitochondrial DNA haplogroups and liver fibrosis in HIV and hepatitis C virus coinfected patients[J].AIDS, 2011, 25 (13) :1619-1926.

施引文献

资源附件(0)

访问统计