Page 79 - 2022-28-中国全科医学

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【Abstract】 Background The status of patients with HIV/AIDS co-infected with HCV considerably varies in different
parts of China. The co-infection of HIV and HCV accelerates the clinical progress of the disease，thereby reducing the patients'
quality of life and exacerbating the occurrence of death. Currently，there are relatively few studies on patients with HIV/AIDS co-
infected with HCV in Guizhou. Objective To analyze the status of patients with HIV/AIDS co-infected with HCV in Guizhou
and its influencing factors and consequently provide basis for its early detection，diagnosis，and treatment. Methods The cases
included in this study were a cohort of HIV/AIDS patients who received antiviral therapy（ART） in the public health rescue
center of Guangzhou from March 2006 to December 2020. Finally，3 084 patients who met the study requirements were included.
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Patients' sex，age，ethnicity，education level，occupation，marital status，route of infection，year of diagnosis，and CD4
T-lymphocytes before ART and anti HCV levels were collected. Multivariate Logistic regression model were used to identify
influencing factors of patients with HIV/AIDS co-infected with HCV. Results Among the 3 084 patients with HIV/AIDS，
202 were co-infected with HCV，and the co-infection rate was 6.55%. There were significant differences in HCV infection rates
among patients with HIV/AIDS of different age groups，education levels，occupations，route of infection（P<0.05）. There were
no significant differences in HCV infection rates among patients with HIV/AIDS by gender，ethnicity，and marital status（P>0.05）.
The prevalence of HCV infection among HIV/AIDS patients tended to decrease with increasing year of diagnosis and increasing
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levels of CD 4 T lymphocytes（P<0.05）. Multivariate Logistic regression analysis showed that the risk of HCV infection was
higher among HIV/AIDS patients aged 30-39 and 40-49 years than among those ≥ 50 years〔OR（95%CI）=2.512（1.374，
4.593），2.802（1.521，5.163），respectively〕，and the risk of HCV infection was higher among HIV/AIDS farmers than
among those in other occupations〔OR（95%CI）=1.926（1.201，3.090）〕. Route of infection of intravenous drug user was
higher for HIV/AIDS patients with HCV infection than for MSM〔OR（95%CI）=39.038（17.559，86.790）〕，and for HIV /
AIDS patients diagnosed 2006—2010，2011—2015，the risk of HCV infection was higher than that for those diagnosed 2016—
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2020〔OR（95%CI）=10.890（6.428，18.447），4.613（2.928，7.269），respectively〕. Those with baseline CD 4 T
lymphocytes <200，200-350，351-499/μl had higher risk of HCV infection among HIV/AIDS patients than those with baseline
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CD 4 T lymphocytes ≥ 500/μl，respectively〔OR（95%CI）=7.120（3.731，13.589），3.614（1.818，7.184），2.795（1.319，
5.922）〕. Conclusion Although the strategy of "exhaustive treatment" for HIV/AIDS has decreased HCV infection rates among
patients with HIV/AIDS in Guizhou，the status still need to be carefully monitored. Early HCV screening should be conducted for
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the HIV/AIDS population，focusing on individuals aged 30-49 years，intravenous drug users，farmers，and those with low CD 4
T-lymphocyte levels.
【Key words】 HIV infections；Acquired immunodeficiency syndrome；Hepatitis C virus；Hepatitis C；Root cause
analysis；Guizhou

全世界有 400 万 ~500 万艾滋病病毒（HIV）感染 疾病负担，提高患者的生存质量。近年来，很多地区对
/ 艾滋病（AIDS）患者合并丙型肝炎病毒（HCV）感染， HIV/AIDS 患者开展了 HCV 检测工作 ［8-10］ ，以期提高
HIV 和 HCV 合并感染已成为全球重要的公共卫生问 HIV/AIDS 患者的抗病毒治疗（ART）效果和生存质量，
题 ［1］ 。由于 HIV 和 HCV 感染具有相似的传播途径、高 但针对贵州省的相关研究相对较少。因此，本研究对贵
风险行为人群、危险因素等，使得 HIV 和 HCV 合并感 阳市公共卫生救治中心接受 ART 的 HIV/AIDS 患者队
染的风险增加 ［2-3］ 。HIV 和 HCV 合并感染除了会引起 列的 HCV 感染情况和影响因素进行分析，从而为早期
机体的单独感染，还会通过两者的相互作用使病毒更容 发现合并感染者、尽早对患者采取个体化治疗提供参考
易在人群中传播，并加剧疾病的临床进展，进而加剧死 依据。
亡的发生 ［4-5］ 。HCV 感染可导致急性、慢性肝炎，若 1 对象与方法
得不到及时、有效的治疗，可能会进展为肝硬化、肝细 1.1 研究对象 病例来源于 2006 年 3 月至 2020 年 12
胞癌等 ［6］ 。目前，AIDS、丙型肝炎均无相应疫苗可预防， 月在贵阳市公共卫生救治中心接受 ART 的 HIV/AIDS 患
但丙型肝炎经过早期、有效的治疗可治愈。直接抗病毒 者队列，所有患者均在贵州省艾滋病确证实验室通过免
药物（direct-acting antiviral agents，DAAs）治疗是丙型 疫印迹法确诊。贵阳市公共卫生救治中心是贵州省贵
肝炎的标准治疗方案，具有治愈率高、疗程短、副作用 阳市传染病专科医院，作为 HIV/AIDS 患者定点治疗医
少、给药简单等优点 ［7］ 。DAAs 的问世，给丙型肝炎患 院，病例来源主要为贵阳市及周边市（州），因此该
者带来了治愈的希望，对于 HIV/AIDS 患者，早期发现 研究队列能够较好地代表贵州地区 HIV/AIDS 患者合并
HCV 感染后，及时开展 DAAs 治疗，可减轻患者的肝脏 HCV 的情况。本研究排除开始 ART 前未行丙型肝炎抗