合并感染丙肝延长HIV感染患者的寿命

tonychant

丙型肝炎――特殊人群――丙肝合并HIV
发表在新奥尔良DDW-2004会议上的本研究的目的是明确HCV合并感染对HIV阳性个体的长期影响。
利用美国VA数据库，研究者对1991年10月到2000年9月的HIV感染者进行了回顾性的队列研究，入选患者要排除先前存在其它肝病，然后随访到2001年9月。
采用死亡率和危险率比（hazard rate ratio，HRR）对死亡进行计算。进行多因素调整以排除人口统计学、合并症死亡、和存在重度HIV。在HAART范围对病人进行独立的分析。
结果：研究者共调查了11678位单纯HIV感染者和4761位HCV-HIV合并感染者。两组在年龄上没有明显的差别（44.4 vs 44.3岁），其中98％为男性。HCV-HIV合并感染组与单纯感染者组相比主要又黑人（58.6 vs 49.8）和西班牙人（10.3 vs 7.8）构成。
在合并感染组共计20531的随访年，期其死亡率为6.27％。而在HIV单纯感染组的39545的随访年中，其年死亡率为12.22％。合并感染HIV-HCV组与单纯感染HIV组的死亡率比例为0.51。
在多因素COX回归分析中，对年龄、种族、性别、诊断年和HIV的严重程度进行调整后，合并感染HCV-HIV组与单纯感染HIV组相比其对死亡调整的HRR为0.81。
对采用高效抗逆转录病毒疗法（Highly Active Anti-Retroviral Therapy，HAART）时期的病人，其死亡的HRR为0.83（0.73-0.93，p＝0.0022）当将HAART时期纳入整个研究时，其结果也是相似的。
这一发现在数个敏感性分析中均取得一致的结果，这些分析包括：第1随访年的生存率、排除哪些合并感染HCV-HIV者中诊断感染HCV在HIV诊断之前者。
最后，将具有先前存在肝病患者排除后，HCV-HIV合并感染组的死亡率下降进一步增加。
总之：本文作者写道：合并感染HCV感染使HIV感染患者的死亡明显降低。这一效应在采用HAART疗法后，略有减弱。
评论：这一回顾性研究的初步结果可能使很多读者感到吃惊，如同作者所说的：这与以前研究发现HCV感染者合并感染HIV后明显加快疾病进展和降低生存率产生鲜明的对比，HIV患者合并感染HCV后似乎可以延长HIV感染者的寿命。
Coinfection with Hepatitis C Virus Prolongs Survival in HIV-Infected Patients
Abstract 224. DDW 2004. May 15-20, New Orleans, LA.
H B El-Serag, T P Giordano, J Souchek, J R Kramer, Peter Richardson.
The objective of the current study, presented at the DDW 2004 conference in New Orleans, LA, was to determine the long-term effect of HCV coinfection on the survival of HIV positive individuals.
Using US VA databases, researchers performed a retrospective cohort study of HIV patients hospitalized between 10/1991 and 9/2000, excluding patients with pre-existing liver disease with follow-up after discharge through 9/2001
Mortality rates and hazard rate ratios (HRR) for mortality were calculated. Multivariate adjustment for differences in demographics, co-morbidities, and HIV disease severity was performed. Separate analyses were performed for patients identified during the HAART era.
Results
The investigators identified 11,678 patients with HIV monoinfection and 4,761 patients with HCV-HIV dual infection. There was not a significant difference in age between the two groups (44.4 vs 44.3 years), and most 98% were men. The dual HCV-HIV infection group was comprised of more blacks (58.6 vs 49.8) and Hispanics (10.3 vs. 7.8), and fewer whites (28.7 vs. 38.6) than the HIV monoinfection group.
During 20,531 person-years of follow-up, the annual mortality rate among patients with dual infection was 6.27%. During 39,545 person-years of follow-up, the annual mortality was 12.22% for HIV monoinfection. The mortality rate ratio of HCV-HIV dual infection relative to HIV monoinfection was 0.51.
In Cox multiple regression, dual HCV-HIV infection had an adjusted HRR for mortality of 0.81 compared to HIV monoinfection (0.72-0.92, P=0.0007), after controlling for age, race, gender, year of diagnosis, and HIV disease severity.
Among HAART-era patients only, the HRR for mortality was 0.83 (0.73-0.93, P=0.0022). Similar findings were observed when HAART era was included as a time dependent variable.
These findings persisted in several sensitivity analyses restricted to patients who survived the first year of follow-up, excluding patients in the dual HCV-HIV group whose HCV infection was diagnosed before their HIV infection.
Finally, the reduced mortality in the HCV-HIV dual infection was exaggerated after excluding patients with liver disease.
In conclusion, the authors write, 揅oinfection with hepatitis C is associated with a significant reduction in the mortality of HIV-infected patients. This effect is less pronounced during the HAART era.?/span>
Commentary
The primary outcome of this retrospective study may surprise many readers, as it did this writer: in sharp contrast to study results showing that coinfection with HIV clearly increases disease progression and decreases survival in HCV-infected individuals, HCV coinfection appears to prolong survival in HIV-infected patients.
Interestingly, these findings are similar to those of recent studies that focus on GB virus C (GBV-C) coinfection with HIV.
05/24/04
Reference
H B El-Serag and others. Coinfection with Hepatitis C Virus Prolongs Survival in HIV-Infected Patients. Abstract 224 (oral). Digestive Disease Week. May 15-20, 2004. New Orleans, LA.

jackwen

谢谢