HCV对HIV/HCV共感染患者病情进展的影响

目的探讨HCV对HIV/HCV共感染病情进展的影响。方法研究对象为2012年8月到北京佑安医院随访的HIV/HCV共感染者29例及HIV单独感染者20例。两组患者年龄、性别及HIV感染时间及感染方式、感染的HIV病毒亚型均具有可比性。外周血生化指标检测并采用瞬时弹性扫描仪FibroScan评估肝脏功能及纤维化程度,运用流式细胞技术检测外周血CD4+T、CD8+T细胞绝对计数。两组计量资料比较采用t检验,计数资料比较采用χ2检验。结果 HIV/HCV共感染组ALT、AST及TBil水平分别为(76.16±81.25)U/L、(87.66±71.32)U/L、(14.21±9.56)μmol/L,明显高于HIV单独感染组[(27.74±20.63)U/L、(45.65±16.95)U/L、(10.26±3.22)μmol/L],差异具有统计学意义(P值分别为0.004、0.005及0.046)。与HIV单独感染组相比,HIV/HCV共感染组Stiffness指数有升高的趋势,但差异无统计学意义(t=1.889,P=0.080)。HIV/HCV共感染组HIV病毒载量(拷贝/ml)的对数值为3.66±0.97明显高于HIV单独感染组的3.02±0.90(t=2.251,P=0.030)。HIV/HCV共感染组、HIV单独感染组CD4+T淋巴细胞计数及CD4+T/CD8+T细胞比例分别为(374.25±185.48)/μl及(0.33±0.17)、(496.45±230.98)/μl及(0.46±0.27),HIV/HCV共感染组CD4+T淋巴细胞计数及CD4+T/CD8+T细胞比例低于HIV单独感染组,差异具有统计学意义,P值分别为0.048、0.043。共感染组艾滋病发病率(27.59%)呈现出较HIV单独感染组(5%)高的趋势(P=0.063)。结论HCV促进HIV/HCV共感染者肝脏损伤,增强HIV复制,加剧机体免疫功能损伤,HCV可能加速HIV/HCV共感染者的病情进展。

Effect of HCV on disease progression in patients with HIV/HCV coinfection

Objective To analyze the effect of hepatitis C virus （HCV）on disease progression in patients with human immunodeficiency vi-rus （HIV）/HCV coinfection.Methods Twenty-nine patients with HIV/HCV coinfection and 20 patients with HIV infection alone,who visited Beijing YouAn hospital for follow-up in August 2012,were enrolled.The two groups of patients were matched for age,sex,time and route of HIV infection,and HIV subtypes.The liver function and fibrosis were evaluated by biochemical testing of peripheral blood and FibroScan.CD4 ＋and CD8 ＋T cell counts were determined by flow cytometry.Results The levels of alanine aminotransferase,aspartate aminotransferase,and total bilirubin for the HIV/HCV coinfection group were 76.16 ±81.25 U/L,87.66 ±71.32 U/L,and 14.21 ±9.56μmol/L,respectively,significantly higher than those for the HIV infection group （27.74 ±20.63 U/L,45.65 ±16.95 U/L,and 10.26 ± 3.22 μmol/L）（P=0.004,0.005,and 0.046）.Compared with the HIV infection group,the HIV/HCV coinfection group had a nonsig-nificantly increased liver stiffness （t=1.889,P=0.080）,a significantly higher viral load （3.66 ±0.97 lg copies/ml vs 3.02 ±0.90 lg copies/ml,t=2.251,P=0.030）,significantly lower CD4 ＋T cell count and CD4 ＋/CD8 ＋ratio （374.25 ±185.48 cells/μl vs 496.45 ± 230.98 cells/μl,P=0.048;0.33 ±0.17 vs 0.46 ±0.27,P=0.043）,and a nonsignificantly higher incidence of AIDS （27.59% vs 5.00%,P=0.063）.Conclusion HCV exacerbates liver damage,enhances HIV replication,increases the impairment of immune func-tion in patients with HIV/HCV coinfection,so it can accelerate the disease progression in these patients.