{"title":"中国西南地区HIV患者合并乙型和丙型肝炎病毒感染的治疗结果:一项观察性队列研究","authors":"Jingya Jia, Qiuying Zhu, Luojia Deng, Guanghua Lan, Andrew Johnson, Huanhuan Chen, Zhiyong Shen, Jianjun Li, Hui Xing, Yuhua Ruan, Jing Li, Hui Lu, Sten H Vermund, Jinhui Zhu, Han-Zhu Qian","doi":"10.1186/s40249-021-00921-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Antiretroviral therapy (ART) has reduced mortality among people living with HIV (PLWH) in China, but co-infections of hepatitis B virus (HBV) and hepatitis C virus (HCV) may individually or jointly reduce the effect of ART. This study aimed to evaluate the impacts of HBV/HCV coinfections on treatment drop-out and mortality among PLWH on ART.</p><p><strong>Methods: </strong>A retrospective cohort study analysis of 58 239 people living with HIV (PLWH) who initiated antiretroviral therapy (ART) during 2010-2018 was conducted in Guangxi Province, China. Data were from the observational database of the National Free Antiretroviral Treatment Program. Cox proportional hazard models were fitted to evaluate the effects of baseline infection of HBV or HCV or both on death and treatment attrition among PLWH.</p><p><strong>Results: </strong>Our study showed high prevalence of HBV (11.5%), HCV (6.6%) and HBV-HCV (1.5%) co-infections. The overall mortality rate and treatment attrition rate was 2.95 [95% confidence interval (CI) 2.88-3.02] and 5.92 (95% CI 5.82-6.01) per 100 person-years, respectively. Compared with HIV-only patients, HBV-co-infected patients had 42% higher mortality [adjusted hazard ratio (aHR) = 1.42; 95% CI 1.32-1.54], HCV-co-infected patients had 65% higher mortality (aHR = 1.65; 95% CI 1.47-1.86), and patients with both HCV and HBV co-infections had 123% higher mortality (aHR = 2.23; 95% CI 1.87-2.66).</p><p><strong>Conclusions: </strong>HBV and HCV coinfection may have an additive effect on increasing the risk of all-cause death among PLWH who are on ART. It is suggested that there is need for primary prevention and access to effective hepatitis treatment for PLWH.</p>","PeriodicalId":13587,"journal":{"name":"Infectious Diseases of Poverty","volume":"11 1","pages":"7"},"PeriodicalIF":4.8000,"publicationDate":"2022-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8734096/pdf/","citationCount":"10","resultStr":"{\"title\":\"Treatment outcomes of HIV patients with hepatitis B and C virus co-infections in Southwest China: an observational cohort study.\",\"authors\":\"Jingya Jia, Qiuying Zhu, Luojia Deng, Guanghua Lan, Andrew Johnson, Huanhuan Chen, Zhiyong Shen, Jianjun Li, Hui Xing, Yuhua Ruan, Jing Li, Hui Lu, Sten H Vermund, Jinhui Zhu, Han-Zhu Qian\",\"doi\":\"10.1186/s40249-021-00921-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Antiretroviral therapy (ART) has reduced mortality among people living with HIV (PLWH) in China, but co-infections of hepatitis B virus (HBV) and hepatitis C virus (HCV) may individually or jointly reduce the effect of ART. This study aimed to evaluate the impacts of HBV/HCV coinfections on treatment drop-out and mortality among PLWH on ART.</p><p><strong>Methods: </strong>A retrospective cohort study analysis of 58 239 people living with HIV (PLWH) who initiated antiretroviral therapy (ART) during 2010-2018 was conducted in Guangxi Province, China. Data were from the observational database of the National Free Antiretroviral Treatment Program. Cox proportional hazard models were fitted to evaluate the effects of baseline infection of HBV or HCV or both on death and treatment attrition among PLWH.</p><p><strong>Results: </strong>Our study showed high prevalence of HBV (11.5%), HCV (6.6%) and HBV-HCV (1.5%) co-infections. The overall mortality rate and treatment attrition rate was 2.95 [95% confidence interval (CI) 2.88-3.02] and 5.92 (95% CI 5.82-6.01) per 100 person-years, respectively. Compared with HIV-only patients, HBV-co-infected patients had 42% higher mortality [adjusted hazard ratio (aHR) = 1.42; 95% CI 1.32-1.54], HCV-co-infected patients had 65% higher mortality (aHR = 1.65; 95% CI 1.47-1.86), and patients with both HCV and HBV co-infections had 123% higher mortality (aHR = 2.23; 95% CI 1.87-2.66).</p><p><strong>Conclusions: </strong>HBV and HCV coinfection may have an additive effect on increasing the risk of all-cause death among PLWH who are on ART. It is suggested that there is need for primary prevention and access to effective hepatitis treatment for PLWH.</p>\",\"PeriodicalId\":13587,\"journal\":{\"name\":\"Infectious Diseases of Poverty\",\"volume\":\"11 1\",\"pages\":\"7\"},\"PeriodicalIF\":4.8000,\"publicationDate\":\"2022-01-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8734096/pdf/\",\"citationCount\":\"10\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Infectious Diseases of Poverty\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s40249-021-00921-5\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infectious Diseases of Poverty","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s40249-021-00921-5","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 10
摘要
背景:抗逆转录病毒治疗(ART)降低了中国HIV感染者(PLWH)的死亡率，但乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)的合并感染可能单独或共同降低抗逆转录病毒治疗的效果。本研究旨在评估HBV/HCV合并感染对抗逆转录病毒治疗中PLWH治疗退出和死亡率的影响。方法:对2010-2018年在中国广西省开始抗逆转录病毒治疗(ART)的58239名HIV感染者(PLWH)进行回顾性队列研究分析。数据来自国家免费抗逆转录病毒治疗计划的观察性数据库。采用Cox比例风险模型来评估HBV或HCV基线感染或两者同时感染对PLWH患者死亡和治疗损耗的影响。结果:我们的研究显示HBV(11.5%)、HCV(6.6%)和HBV-HCV(1.5%)合并感染的患病率很高。总死亡率和治疗损耗率分别为2.95[95%可信区间(CI) 2.88-3.02]和5.92 (95% CI 5.82-6.01) / 100人年。与仅感染hiv的患者相比，hbv合并感染患者的死亡率高出42%[校正危险比(aHR) = 1.42;95% CI 1.32-1.54]， hcv合并感染患者的死亡率高出65% (aHR = 1.65;95% CI 1.47-1.86)， HCV和HBV合并感染的患者死亡率高出123% (aHR = 2.23;95% ci 1.87-2.66)。结论:HBV和HCV合并感染可能会增加接受抗逆转录病毒治疗的艾滋病毒感染者全因死亡的风险。建议有必要对PLWH进行一级预防和获得有效的肝炎治疗。
Treatment outcomes of HIV patients with hepatitis B and C virus co-infections in Southwest China: an observational cohort study.
Background: Antiretroviral therapy (ART) has reduced mortality among people living with HIV (PLWH) in China, but co-infections of hepatitis B virus (HBV) and hepatitis C virus (HCV) may individually or jointly reduce the effect of ART. This study aimed to evaluate the impacts of HBV/HCV coinfections on treatment drop-out and mortality among PLWH on ART.
Methods: A retrospective cohort study analysis of 58 239 people living with HIV (PLWH) who initiated antiretroviral therapy (ART) during 2010-2018 was conducted in Guangxi Province, China. Data were from the observational database of the National Free Antiretroviral Treatment Program. Cox proportional hazard models were fitted to evaluate the effects of baseline infection of HBV or HCV or both on death and treatment attrition among PLWH.
Results: Our study showed high prevalence of HBV (11.5%), HCV (6.6%) and HBV-HCV (1.5%) co-infections. The overall mortality rate and treatment attrition rate was 2.95 [95% confidence interval (CI) 2.88-3.02] and 5.92 (95% CI 5.82-6.01) per 100 person-years, respectively. Compared with HIV-only patients, HBV-co-infected patients had 42% higher mortality [adjusted hazard ratio (aHR) = 1.42; 95% CI 1.32-1.54], HCV-co-infected patients had 65% higher mortality (aHR = 1.65; 95% CI 1.47-1.86), and patients with both HCV and HBV co-infections had 123% higher mortality (aHR = 2.23; 95% CI 1.87-2.66).
Conclusions: HBV and HCV coinfection may have an additive effect on increasing the risk of all-cause death among PLWH who are on ART. It is suggested that there is need for primary prevention and access to effective hepatitis treatment for PLWH.
期刊介绍：
Infectious Diseases of Poverty is a peer-reviewed, open access journal that focuses on essential public health questions related to infectious diseases of poverty. It covers a wide range of topics and methods, including the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies, and their application.
The journal also explores the impact of transdisciplinary or multisectoral approaches on health systems, ecohealth, environmental management, and innovative technologies. It aims to provide a platform for the exchange of research and ideas that can contribute to the improvement of public health in resource-limited settings.
In summary, Infectious Diseases of Poverty aims to address the urgent challenges posed by infectious diseases in impoverished populations. By publishing high-quality research in various areas, the journal seeks to advance our understanding of these diseases and contribute to the development of effective strategies for prevention, diagnosis, and treatment.
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