人类免疫缺陷病毒合并乙型肝炎病毒感染患者高效抗反转录病毒治疗效果和肝脏损伤研究  

Response and liver injury of highly active antiretroviral therapy on human immunodeficiency virus and hepatitis B virus co-infection

作　　者：胡庆玲[1] 谢元林[1] 

机构地区：[1]南华大学附属长沙医院感染科,湖南长沙410005

出　　处：《广东医学》2017年第7期1029-1031,共3页Guangdong Medical Journal

基　　金：湖南省研究生科研创新项目(编号:CX2016B495)

摘　　要：目的对人类免疫缺陷病毒(HIV)合并乙型肝炎病毒(HBV)感染患者高效抗反转录病毒治疗(HAART)的临床效果和伴随的肝脏损伤情况作出评价。方法将患者按有无HBV合并感染分为HIV单纯感染组75例和HIV/HBV合并感染组69例,应用HAART方案治疗1年,对比观察患者血浆HIV载量,外周血CD4^+T淋巴细胞计数、丙氨酸氨基转移酶等指标变化。结果治疗前,HIV单纯感染组和HIV/HBV合并感染组的HIV载量均值分别为6.31和5.85 log_(10)copies/m L,治疗12个月后,分别降低至2.90 log_(10)copies/m L(P<0.05)和2.93 log_(10)copies/m L(P<0.05),两组HIV RNA抑制率分别为82.67%和92.75%。HIV单纯感染组和HIV/HBV合并感染组CD4^+T细胞均值由治疗前的77.8个/μL和75.4个/μL,分别上升到221.4个/μL和214.3个/μL(P<0.05)。1年内HIV单纯感染组和HIV/HBV合并感染组的肝功能异常率分别为6.4%和19.7%(P<0.05),但HAART期间无因发生严重肝脏损伤而停止治疗的患者。结论应用HAART的HIV/HBV合并感染患者,短期内可以有效抑制HIV病毒复制,重建患者的免疫功能;HBV可能因促进HIV复制而加重肝损伤与免疫损伤,但并不影响HAART的效果。Objective To evaluate the efficacy and liver injury of highly active antiretroviral therapy （HARRT） for human immunodeficiency virus （HIV） - hepatitis B virus （HBV） co - infection. Methods One hundred and forty - four acquired HIV patients were recruited and divided into HIV group （75 HIV sole infection） and HIV/HBV group （69 HIV- HBV co- infection）. HARRT was given for one year. Viralm load（VL） , CD4 cell count and alanine aminotrans- ferase （ALT） were measured in follow -up survey. Results After one year HARRT, mean HIV VL level was reduced from 6. 31 logl0 copies/mL to 2. 90 loglo eopies/mL in HIV group （P 〈 0. 05 ） and from 5.85 logl0 copies/mL to 2. 93 logl0 copies/mL in HIV/HBV group （P 〈 0. 05 ） ; with HIV RNA suppression rates of 82. 67% and 92. 75% , respectively. Meanwhile, mean CD4 cell counts were increased gradually from 77.8/μL to 221.4/μL in HIV group （P 〈0. 05） , and from 75.4/μL to 214. 3/μL in HIV/HBV group （P 〈0.05）. During the one year treatment, the liver injury rates in HIV group and HIV/HBV group were 6. 4% and 19. 7%, respectively （P 〈 0. 05 ）. However, no patient discontinued HARRT because of serious liver injury. Conclusion HARRT can effectively inhibit HIV RNA replication, and reconstruct im- mune system in HIV - HBV co - infection. HBV may has promote HIV RNA replication, which makes a worse liver and immune system damages in co - infection, but not affect the treatment effect.

关 键 词：人类免疫缺陷病毒 乙型肝炎病毒 高效抗反转录病毒治疗 肝脏损伤 

分 类 号：R512.91[医药卫生—内科学]