2008-2018年某院167例丙型肝炎病毒合并人类免疫缺陷病毒感染者的临床特征及治疗

目的探讨丙型肝炎病毒（HCV）合并人类免疫缺陷病毒（HIV）感染者的临床特征及治疗现状，为HIV/HCV共感染的治疗提供科学指导。 方法基于医院信息系统真实世界数据，提取2008年5月至2018年5月新疆维吾尔自治区第六人民医院（传染病医院）和新疆维吾尔自治区人民医院收治的167例HIV/AIDS患者的病历资料。依据医嘱记录，对HIV/HCV共感染者按照抗HCV方案分为聚乙二醇化干扰素α-2b（PegIFNα-2b）联合利巴韦林（RBV）治疗组（PegIFN组、62例），普通干扰素联合RBV治疗组（IFN组、46例）与直接抗病毒药物（DAAs）治疗组（DAAs组、59例）；分析3组患者CD4⁺ T淋巴细胞、丙氨酸氨基转移酶（ALT）和天门冬氨酸氨基转移酶（AST）的变化、病毒学应答及不良反应发生率。 结果共收集659例HIV/AIDS感染者的临床资料，其中合并HCV感染共计167例，合并感染率为25.34%。HCV基因型别主要为：3b型43例、3a型41例、1b型32例、6a型21例、未分出亚型25例、2a型5例，以3型最多，占50.29%（84/167）。其中经静脉吸毒感染占29.40%（142/483），性传播占14.20%（23/162），其他占14.29%（2/14）。125例患者无明显症状，42例患者出现虚弱、发热、盗汗、肝硬化、淋巴结肿大等症状。肝功能检查发现：肝功能正常者56例（56/167、33.53%），肝功能异常者111例（111/167、66.47%），其中12例为肝硬化代偿期，7例为肝硬化失代偿期。HIV/HCV共感染率自2008年的37.25%下降至2018年的15.00%，且呈逐年下降，趋势卡方检验显示差异有统计学意义（χ² = 263.190、P < 0.001）。HIV/HCV共感染者CD4⁺ T细胞计数显著高于单纯HIV/AIDS患者（t = 7.203、P < 0.001），总胆红素（TBil）（t = 29.101、P < 0.001）、ALT（t = 25.382、P < 0.001）、AST（t = 30.984、P < 0.001）、HIV RNA（t = 9.190、P < 0.001）均显著低于单纯HIV/AIDS患者，差异均有统计学意义。各组患者治疗后CD4⁺ T淋巴细胞数均较治疗前升高，且DAAs组患者高于PegIFN组和IFN组；3组患者治疗后ALT、AST水平均较治疗前降低，且DAAs组患者高于PegIFN组和IFN组，差异具有统计学意义（CD4⁺ T淋巴细胞数：F = 4.252、P = 0.016；ALT：F = 125.400、P < 0.001；AST：F = 37.990、P < 0.001）。DAAs组患者早期病毒学应答率（EVR）（96.61%）高于PegIFN组（77.42%）和IFN组（71.74%）；DAAs组患者治疗结束病毒学应答率（ETVR）（96.61%）高于PegIFN组（72.58%）和IFN组（63.04%）；DAAs组患者持续病毒学应答率（SVR）（94.92%）高于PegIFN组（69.35%）和IFN组（67.39%）；差异均有统计学意义（EVR：χ² = 13.011、P = 0.001；ETVR：χ² = 19.227、P < 0.001；SVR：χ² = 14.474、P < 0.001）。DAAs组患者乏力、发热、白细胞下降、血红蛋白下降、血小板下降发生率均低于PegIFN组和IFN组，差异均有统计学意义（乏力：χ² = 6.678、P = 0.035；发热：χ² = 12.485、P = 0.002；白细胞下降：χ² = 10.256、P = 0.006；血红蛋白下降：χ² = 13.962、P = 0.001；血小板下降：χ² = 11.681、P = 0.003）。 结论HIV/HCV共感染率较高，以HCV基因3型最为常见，感染率呈逐年下降趋势，主要通过静脉吸毒途径传播。DAAs治疗HIV/HCV共感染更有利于患者免疫功能、肝功能的恢复，获得更高SVR，安全性较高。

Clinical features and treatment of 167 patients with hepatitis C virus and human immunodeficiency virus coinfection in a hospital from 2008 to 2018

ObjectiveTo investigate the clinical characteristics and treatment status of patients with hepatitis C virus (HIV) and human immunodeficiency virus (HIV) infection, and to provide scientific guidance for HIV/HCV co-infection treatment. MethodsBased on real-world data from hospital information system, medical records of 167 patients with HIV/acquired immune deficiency syndrome (AIDS) from the Sixth People’s Hospital of Xinjiang Uygur Autonomous Region (Infectious Diseases Hospital) and Xinjiang Uygur Autonomous Region People’s Hospital were collected from May 2008 to May 2018. According to medical records, patients with HIV/HCV co-infection were divided into polyethylene glycol interferon-α-2b (PegIFNα-2b) and ribavirin (RBV) treatment group (PegIFN group: 62 cases), common IFN and RBV treatment group (IFN group: 46 cases) and direct acting antivirals (DAAs) treatment group (DAAs group: 59 cases). The changes of CD4⁺ T lymphocytes, alanine transaminase (ALT), aspartate transaminase (AST), virological response and adverse reactions in the three groups were analyzed, respectivly. ResultsTotal of 659 cases with HIV/AIDS were collected, among which, 167 cases were complicated with HCV infection, the complicated infection rate was 25.34%. The main HCV genotypes were type 3b (43 cases), type 3a (41 cases), type 1b (32 cases), type 6a (21 cases), undifferentiated subtype (25 cases), type 2a (5 cases); among which type 3 was the most, accounting for 50.29% (84/167). Among them, intravenous drug use accounted for 29.40% (142/483), sexual transmission accounted for 14.20% (23/162) and others accounted for 14.29% (2/14). Total of 125 patients had no obvious symptoms, and 42 patients had symptoms such as weakness, fever, night sweats, liver cirrhosis and lymphadenopathy. Liver function detection showed that 56 cases (56/167, 33.5%) were with normal liver function, 111 cases (111/167, 66.5%) with abnormal liver function, including 12 cases with cirrhosis in compensatory stage, 7 cases with degeneration of cirrhosis repayment period. The HIV/HCV coinfection rate dropped from 37.25% in 2008 to 15.00% in 2018, which showed a downward trend year by year (χ² = 263.190, P < 0.001). The CD4⁺ T cell count of patients with HIV/HCV coinfection was significantly higher than that of patients with HIV/AIDS (t = 7.203, P < 0.001); but total bilirubin (TBil) (t = 29.101, P < 0.001), ALT (t = 25.382, P < 0.001), AST (t = 30.984, P < 0.001), HIV RNA (t = 9.190, P < 0.001) were significantly lower than those of patients with HIV/AIDS, all with significant differences. The amounts of CD4⁺ T lymphocytes in each group after treatment were higher than those before treatment, which was higher of patients in DAAs group than those of PegIFN group and IFN group; the levels of ALT and AST after treatment in three groups were lower than those before treatment, which higher of DAAs group was than those of in PegIFN group and IFN group, all with significant differences (CD4⁺ T: F = 4.252, P = 0.016; ALT: F = 125.400, P < 0.001; AST: F = 37.990, P < 0.001). The early virological response (EVR) rate (96.61%) of patients in DAAs group was significantly higher than that of PegIFN group (77.42%) and IFN group (71.74%); the end of treatment virological response (ETVR) rate (96.61%) of patients in DAAs group was significantly higher in PegIFN group (72.58%) and IFN group (63.04%). The sustained virological response (SVR) rate (94.92%) of DAAs group was significantly higher than those of PegIFN group (69.35%) and IFN group (67.39%), all with significant differences (EVR: χ² = 13.011, P = 0.001; ETVR: χ² = 19.227, P < 0.001; SVR: χ² = 14.474, P < 0.001). The incidence of adverse reactions such as fatigue, fever, decreased white blood cells, decreased hemoglobin and decreased platelets of patients in DAAs group were significantly lower than those of PegIFN group and IFN group, with significant differences (fatigue: χ² = 6.678, P = 0.035; fever: χ² = 12.485, P = 0.002; decreased white blood cell: χ² = 10.256, P = 0.006; decreased hemoglobin: χ² = 13.962, P = 0.001; decreased platelet: χ² = 11.681, P = 0.003). ConclusionsThe HIV/HCV coinfection rate was high, with HCV genotype 3 the most common, showing a year-on-year downward trend, and spreading mainly through intravenous drug use. DAAs for HIV/HCV co-infected patients were more conducive to the recovery of immune function and liver function, with a higher SVR rate and higher safety.