传染性命令是人类免疫缺陷病毒、乙型肝炎病毒和丙型肝炎病毒联合感染者肝纤维化进展的风险因素之一

E. P. Feoktistova, D. Konstantinov, E. Malova, I. Balmasova
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摘要

HIV/HCV/HBV三重合并感染时,由于肝纤维化进展迅速或发展为肝细胞癌,预后明显较差,预期寿命也较短。本研究的目的是验证以下假设:HIV/HCV/HBV 合并感染不利病程的风险因素之一是传染顺序和合并感染的间隔时间。研究分析了 97 名合并感染 HIV/HCV/HBV 1-2 年的患者的病理数据和直接随访结果。患者被分为三个研究组:(1) HIV 为第一病原体,(2) HCV 为第一病原体,(3) HBV 为第一病原体。每位患者从感染第一种病原体到感染第二种病原体之间的间隔时间(以年为单位)都被考虑在内。在后续治疗期间,通过 PCR 评估病毒 HIV、HCV 和 HBV 的载量,并每年进行瞬时肝纤维化活检,使用 METAVIR 评分系统确定肝纤维化阶段。HIV/HCV/HBV合并感染时,当HIV或HBV是第一病原体时,进展性肝纤维化的风险较高,但HBV和其他病毒的感染间隔为10年。同时,肝纤维化的稳定过程与 HBV 病毒载量大于 7 200 拷贝/毫升有关。在风险组中,最有效的抗逆转录病毒疗法是逆转录酶抑制剂、HIV蛋白酶抑制剂和直接抗病毒(抗HCV)药物的组合。因此,HIV/HCV/HBV三重合并感染中的感染顺序和病原体获得的间隔时间对肝纤维化的进展有重要影响,这就要求在组织诊断检测和控制抗逆转录病毒疗法时采取特定的方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Contagious order as a risk factor for liver fibrosis progression in co-infection with human immunodeficiency virus, hepatitis B and C viruses
In triple co-infection with HIV/HCV/HBV, the prognosis is significantly poorer and life expectancy is lower because of the rapid progression of liver fibrosis or development of hepatocellular carcinoma. The aim of this study was to test the hypothesis that one of the risk factors for the unfavorable course of HIV/HCV/HBV co-infection is contagious order and the interval between coinfections. The study analyzed anamnestic data and the results of direct follow-up of 97 patients co-infected with HIV/HCV/HBV for 1-2 years. Patients were divided into three study groups: (1) HIV as the first pathogen, (2) HCV as the first pathogen, and (3) HBV as the first pathogen. For each patient, the period (in years) between the acquisition of the first and subsequent pathogens was considered. During the fol-low-up period, viral HIV, HCV, and HBV load was assessed by PCR, and annual transient liver fibro-elastometry was performed to determine the fibrosis stage using the METAVIR scoring system. The risk of progressive liver fibrosis in HIV/HCV/HBV co-infection is higher when HIV or HBV is the first pathogen, but the interval between the acquisition of HBV and other viruses is 10 years. Meanwhile, a stable course of liver fibrosis is associated with an HBV viral load of >7,200 copies/ml. In the risk group, the most effective antiretroviral therapy was a combination of reverse transcriptase inhibitors, HIV protease inhibitors, and direct antiviral (anti-HCV) drugs. Therefore, the order of infection and intervals between pathogen acquisition in triple co-infection with HIV/HCV/HBV have a significant effect on liver fibrosis progression, which requires specific approaches to the organization of diagnostic tests and the control of antiretroviral therapy.
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