南通市HIV合并HBV感染者抗逆转录病毒疗效及影响因素分析  

Analysis of anti⁃retroviral efficacy and influencing factors in HBV/HIV co⁃infection in Nantong City

作　　者：潘一茹 邱涛[2] 马平[3] 周小毅[3] 丁萍[2] 陈彦君 姜洁[2] 何楚 钱姣 孔泉 邹美银[4] 翟祥军[1,2] PAN Yiru;QIU Tao;MA Ping;ZHOU Xiaoyi;DING Ping;CHEN Yanjun;JIANG Jie;HE Chu;QIAN Jiao;KONG Quan;ZOU Meiyin;ZHAI Xiangjun(School of Public Health,Nanjing Medical University,Nanjing 211166;Jiangsu Provincial Center for Disease Control and Prevention,Nanjing 210009;Nantong Center for Disease Control and Prevention,Nantong 226000;Department of Infectious Diseases,Nantong Third People’s Hospital(Affiliated Nantong Hospital No.3 of Nantong University),Nantong 226000,China)

机构地区：[1]南京医科大学公共卫生学院,江苏南京211166 [2]江苏省疾病预防控制中心,江苏南京210009 [3]南通市疾病预防控制中心,江苏南通226000 [4]南通市第三人民医院(南通大学附属南通第三医院)感染科,江苏南通226000

出　　处：《南京医科大学学报（自然科学版）》2024年第7期972-978,共7页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省十四五流行病学重点学科(ZDXK202250)。

摘　　要：目的:了解人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者合并乙型肝炎病毒(hepatitis B virus,HBV)的感染现况和特征,分析HIV/HBV合并感染者抗逆转录病毒治疗(anti-retroviral therapy,ART)效果及影响因素。方法:选取南通市2016年1月—2021年12月新确诊的HIV感染者为调查对象,根据乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)检测结果分为HIV单独感染组1 830例和HIV/HBV合并感染组135例,比较两组患者ART前HIV感染特征,分析ART后HIV病毒学抑制和CD4+T淋巴细胞变化情况,以评估免疫功能改善情况及影响因素。结果:HIV/HBV合并感染者ART前免疫受损重于HIV单独感染者。接受ART后,HIV单独感染组和HIV/HBV合并感染组的CD4+T计数总体上均随治疗时间延长呈上升趋势,ART 2年后,两组患者的HIV病毒学抑制率均为90%以上。单因素和多因素Logistic回归分析均显示开始ART的年龄增加、初始CD4+T <200个/μL、初始HIV RNA≥4.5[lg(copies/mL)]是影响免疫重建的危险因素。随治疗时间的延长,免疫重建良好率有增加趋势。在ART前合并HBV感染加重HIV感染者的免疫损伤,因而可能影响免疫重建。结论:HBV感染可加重HIV感染者的免疫损伤,现行HIV/HBV合并感染的ART策略可有效抑制双重感染,有利于HIV/HBV合并感染者的免疫重建。在感染者的干预管理中,ART及疗效监测均存在不足,临床诊疗活动需进一步规范。Objective:To investigate the current situation and characteristics of human immunodeficiency virus(HIV)/hepatitis B virus(HBV)co-infection among HIV-infected individuals,as well as to analyze the effectiveness of anti-retroviral therapy(ART)and its influencing factors for HIV/HBV co-infected patients.Methods:The study selected newly diagnosed HIV patients in Nantong City from January,2016,to December,2021,as the research subjects.Based on the results of hepatitis B surface antigen(HBsAg)testing,the patients were categorized into two groups:an HIV mono-infection group(1830 cases)and an HIV/HBV co-infection group(135 cases).The study compared the HIV infection characteristics of the two groups before ART,analyzed the virological suppression and CD4+T lymphocyte count changes after ART therapy,and evaluated the improvement of immune function and its influencing factors.Results:HIV/HBV co-infection led to more severe immune impairment of the patients before ART than those in the HIV mono-infection group.After receiving ART,both the HIV mono-infection group and the HIV/HBV co-infection group showed a gradual increase in CD4+T count,and the virological suppression rate was over 90%in both groups after two years of ART.Univariate and multivariate logistic regression analyses showed that the increasing age at ART initiation,initial CD4+T count<200 cells/μL,and initial HIV RNA≥4.5[lg(copies/mL)]were risk factors for immune reconstitution.There was also an increasing trend in the rate of favorable immune reconstitution with a prolonged treatment time.Co-infection with HBV exacerbated immune impairment in HIV-infected individuals before ART,which may affect immune reconstitution.Conclusion:HBV infection can worsen immune damage in HIV-infected individuals.The current ART strategy for HIV/HBV co-infection effectively suppresses dual infection and benefits immune reconstitution in HIV/HBV co-infection.However,there are insufficiencies in ART and efficacy monitoring in patient management,highlighting the need for further st

关 键 词：人类免疫缺陷病毒 乙型肝炎病毒 合并感染 抗逆转录病毒治疗 

分 类 号：R512.91[医药卫生—内科学] R512.62[医药卫生—临床医学]