HCV RNA对HIV合并HCV感染者高效抗逆转录病毒治疗的影响  

Effect of HCV RNA on response to highly active antiretroviral therapy in HIV/HCV co-infected patients

作　　者：刘静[1] 张旻[1] 朱谦[2] 何昌宇 胡清海[1] 赵连爽[1] 代娣[1] 丁海波[1] 楚振兴[1] 徐俊杰[1] 姜拥军[1] 尚红[1] 

机构地区：[1]中国医科大学附属第一医院卫生部艾滋病免疫学重点实验室,沈阳110001 [2]河南省疾病预防控制中心 [3]河南省唐河县疾病预防控制中心

出　　处：《中华检验医学杂志》2009年第4期372-376,共5页Chinese Journal of Laboratory Medicine

基　　金：国家科技重大专项课题资助项目（2008ZX10001-001）;卫生部艾滋病防治应用性研究项目（WA2006-02）;辽宁省教育厅高等学校创新团队项目计划（2008T202）;辽宁省医学重点专科项目（辽卫函字[2007]499号）

摘　　要：目的探讨HCV RNA对HIV和HCV合并感染者接受高效抗反转录病毒治疗（highly active antiretroviral therapy，HAART）后疗效、肝脏功能和血脂的影响。方法招募我国河南既往有偿供血人群中接受HAART治疗的HIV／HCV合并感染者275例，每6个月随访一次，定期检测HCV RNA、HIV RNA、CD4T淋巴细胞计数、肝脏功能指标和血脂等实验室指标，采用卡方检验、成组设计秩和检验比较HCV RNA阳性组和HCV RNA阴性组HAART治疗后HIV病毒抑制率、免疫学应答、肝损伤和血脂的差异。结果HAART治疗6月以上患者中，HCV RNA阳性组和HCV RNA阴性组HIV完全抑制率差异无统计学意义（45．6％vs．38．5％，Х^2=1．150，P〉0．05）；HAART治疗前（286个／μl vs．209个／μl，Z=0．734，P=0．463）、治疗后6个月（310个／μl vs．362个／μl，Z=0．562，P=0．574）、12个月（378个／μl vs．289个／μl，Z=1．091，P=0．275）、18个月（363个／μl vs．288个／μl，Z=1．435，P=0．151）、24个月（413个／μl vs．348个／μl，Z=0．939，P=0．348）CD4^＋T淋巴细胞计数在HCV RNA阳性组和HCV RNA阴性组间差异无统计学意义。HCV RNA阳性组血清ALT（55．0U／L vs．29．5U／L，Z=6．789，P〈0．01）、AST（46．0U／L vs．33．0U／L，Z=4．890，P〈0．01）、TBIL（9．3mmol／L vs．7．2mmol／L，Z=3．748，P〈0．01）水平显著高于HCV RNA阴性组；HCV RNA阳性组HAART治疗后发生肝损伤的风险显著高于HCV RNA阴性组（调整后优势比aOR=3．8，P〈0．01）。HIV／HCV合并感染者HCV RNA阳性组TG水平显著低于HCV RNA阴性组（1．2mmol／L vs．1．4mmol／L，Z=1．936，P=0．043）、而HDL-C水平显著高于HCV RNA阴性组（1．5mmol／L vs．1．3mmol／L，Z=2．251，P=0．024）。结论HCV RNA对HIV／HCV合并感染者HAART治疗后HIV病毒抑制率无影响，亦不影响HAART治疗后CD4^＋T淋巴细胞的恢复；HCV RNA是HIV／HCV合并感染者HAART治疗后肝损�Objective To investigate the effect of HCV RNA on virological and immunological response to highly active antiretroviral therapy （ HAART）, liver function and blood lipid levels in HIV/HCV co-infected patients. Methods In a cohort study,275 HIV/HCV co- infected former blood donors receiving HAART were followed up every six month in Henan province in China. HCV RNA, HIV RNA, CD4^＋ T cell counts, indexes of liver function and lipid levels were periodically tested. The differences of HIV viral load suppression, immunological response, liver injury and blood lipid levels between HCV RNA positive group and negative group were compared by Х2 test and two independent-samples tests. Result There was no significant difference of HIV viral load suppression between HCV RNA positive group and HCV RNA negative group six-month treatment （45. 6% vs. 38.5% ,Х^2 = 1. 150, P 〉 0. 05 ） and CD4^＋ T cell counts before （286 cells/μl vs. 209 cells/μl, Z = 0. 734, P = 0. 463 ） and after 6-month （ 310 cells/μl vs. 362 cells/μl, Z = 0. 562, P = 0. 574）, 12-month（378 cells/μl vs. 289 cells/μl, Z = 1. 091, P = 0. 275 ）, 18-month（363 cells/μl vs. 288 cells/μl, Z = 1. 435, P =0. 151 ） ,24-month（413 cells/μl vs. 348 cells/μl, Z =0. 939, P = 0. 348 ） HAART. The mean levels of serum ALT （55.0 U/L vs. 29. 5 U/L, Z = 6. 789, P 〈 0. 01） ,AST（46. 0 U/L vs. 33.0 U/L, Z = 4. 890, P 〈 0.01 ） ,TBIL （9. 3 mmol/L vs. 7.2 mmol/L, Z =3. 748, P 〈0.01 ）were significantly higher in HCV RNA positive group than that in HCV RNA negative group. HCV RNA was the independent variables associated with liver injury after HAART （aOR = 3.8, P 〈 0. 01 ）. The serum triglyceride level was higher in HCV RNA positive group than that in HCV RNA negative group（ 1.2 mmol/L vs. 1.4 mmol/L, Z = 1. 936, P =0. 043） . The serum HDL level was higher in HCV RNA positive group than that in HCV RNA negative group （ 1.5 mmol/L vs. 1.3 mmol/L, Z =2. 251, P = 0. 024 ）. Conclusions HCV RNA does not affect HIV virolo

关 键 词：HIV感染 肝炎 丙型 抗逆转录病毒治疗 高效 RNA 病毒 

分 类 号：R686[医药卫生—骨科学]