Effects of combination antiretroviral therapy on acquired immunodeficiency syndrome complicated with malignant tumors / 中华传染病杂志

Objective:To investigate the epidemic trend and risk change of acquired immunodeficiency syndrome (AIDS) complicated with malignant tumors after combination antiretroviral therapy (cART).Methods:The types of malignant tumors in patients with AIDS at different stages of cART were analyzed among anti-human immunodeficiency virus (HIV)-positive population in Hubei Province screened in National AIDS/HIV prevention and control information system from 1st January, 2004 to 31st December, 2018. The standardized incidence ratios(SIR) of malignant tumors in AIDS patients was analyzed based on the incidence of malignant tumors in the general population in Hubei Province or China in 2013. The changes in risks for development of malignant tumors in AIDS patients at different cART stages from 2004 to 2013 and 2014 to 2018 were compared.Chi-square test was used for statistical analysis.Results:Three hundred and twenty-three out of 22 994 AIDS patients were diagnosed with malignant tumors. Non-Hodgkin lymphoma(NHL) and cervical cancer were most common types in acquired immunodeficiency syndrome-defining cancers (ADC), while liver cancers and lung cancers were the most common types in non-acquired immunodeficiency syndrome-defining cancers (NADC). The overall risk of malignancy in AIDS patients was similar to that in the general population (SIR=1.06, χ2=0.62, P=0.426). However, the risks of Kaposi sarcoma, NHL, Hodgkin lymphoma, cervical cancer, and head and face cancers (excepting nasopharyngeal cancer) in AIDS patients were significantly higher than those in the general population (SIR=834.09, 9.65, 13.33, 5.22 and 2.94, respectively, χ2=11 747.27, 625.54, 56.65, 184.21 and 13.66, respectively, all P<0.01). The risks of lung cancer, colorectal anal cancer, stomach cancer and breast cancer in AIDS patients were significantly lower than those in the general population (SIR=0.33, 0.36, 0.43 and 0.45, respectively, χ2=33.43, 12.84, 9.01 and 7.21, respectively, all P<0.05). The SIR of cervical cancer, liver cancer and colorectal anal cancer from 2014 to 2018 were 4.06, 0.43 and 0.10, respectively, which were significantly lower than those from 2004 to 2013 (7.42, 1.96 and 0.84, respectively). The differences were all statistically significant ( χ2=5.39, 19.52 and 10.86, respectively, all P<0.05). Conclusions:At present, there are no significant differences of the incidences of malignant tumors between AIDS patients and general population, but the tumor types are different. The most common malignant tumors in this region are NHL and cervical cancer, which should be noted that HIV screening among patients with such tumors is conducive to comprehensive treatment to improve the efficacy.

Cancer incidence among HIV/AIDS population in Hubei province / 中华全科医师杂志

The data of patients with HIV/AIDS from Hubei Province during 2004 to 2018 were obtained from the National AIDS Comprehensive Prevention and Control Information System. A total of 22 980 HIV-positive or AIDS patients were followed up for 113 164 person-years and 323 malignant tumors were diagnosed. Non-Hodgkin′s lymphoma (NHL), cervical cancer, liver cancer, lung cancer, and Kaposi sarcoma (KS) accounted for 70.0% (226/323) of all malignant tumors in this population. The average crude incidence and mortality of malignant tumors in HIV-infected patients were 285.43/100 000(269.11/100 000 in males and 325.87/100 000 in females), and 169.67/100 000(184.78/100 000 in males and 132.19/100 000 in females), respectively. The result indicates that the overall cancer incidence and mortality in HIV/AIDS population under widely implementation of combination anti-retroviral therapy (cART) are similar to those in the general population of the region. But the incidence and mortality of AIDS-related tumors such as KS, NHL, HD and cervical cancer are higher than those in general population, and attention should be given to screening of these malignancies in HIV/AIDS population.

Retrospective analysis of the effect of CD4 + T lymphocyte level on hepatitis B surface antibody in human immunodeficiency virus infected patients / 中华传染病杂志

Objective:To investigate the relationship between positive rate and titer of hepatitis B surface antibody (anti-HBs) and CD4 + T lymphocyte count level in human immunodeficiency virus (HIV) infected patients after hepatitis B virus (HBV) exposure. Methods:A total of 4 893 HIV-infected patients were admitted to Zhongnan Hospital of Wuhan University from January 2010 to December 2018. The demographic data, HIV-related diagnosis, treatment information, CD4 + T lymphocyte count and serum markers of HBV infection of HIV infected patients were retrospectively analyzed. The patients were grouped according to the CD4 + T lymphocyte count and serum markers of HBV infection, and the differences of anti-HBs positive rate and HBV exposure rate in patients with different CD4 + T lymphocyte counts were compared.The differences of CD4 + T lymphocyte count in patients with different titer of anti-HBs were compared. Statistical analysis was performed using chi-square test, analysis of variance or t test. Results:Patients with HIV infection were divided into CD4 + T lymphocyte count<200/μL group (3 293 cases), 200-500/μL group (1 200 cases) and CD4 + T lymphocyte count>500/μL group (400 cases). The HBV exposure rates in the three groups were 78.0%(2 569/3 293), 77.0%(924/1 200) and 76.2%(305/400), respectively. The anti-HBs positive rates were 38.2%(1 258/3 293), 53.8%(645/1 200) and 62.5%(250/400), respectively. The anti-HBs titers were (120.00±36.45) IU/L, (148.00±26.40) IU/L and (212.00±92.08) IU/L, respectively. The exposure rates of HBV in the three groups were similar ( χ2=0.992, P=0.609), but the positive rates and titers of anti-HBs were significantly different ( χ2=146.779 and F=45.362, respectively, both P<0.01). When the patients were grouped by anti-HBs titer, 2 740 cases were divided into anti-HBs negative group (<10 IU/L), 1 220 cases in low anti-HBs group (10-99 IU/L), 693 cases in medium anti-HBs group (100-499 IU/L) and 240 cases in high anti-HBs group (≥500 IU/L). The CD4 + T lymphocyte count levels of the four groups were (150.00±8.42)/μL, (185.00±7.08)/μL, (243.00±12.07)/μL and (308.00±22.60)/μL, respectively. The overall CD4 + T lymphocyte count levels among the four groups were significantly different ( F=68.479, P<0.01). Among the 90 HIV infected patients who received anti-retroviral therapy (ART), the anti-HBs titer increased from (91.96±21.87) IU/L to (200.76±56.43) IU/L after treatment, and the anti-HBs level before and after treatment was significantly different ( t=-2.542, P=0.035). Among 208 patients with negative HBV markers, no patients had hepatitis B surface antigen switched to positive when monitored for an interval time of (26.2±5.3) months. Conclusions:The risk of HBV exposure in patients with HIV infection is not significantly related to the disease stage, but the positive rate and titer of anti-HBs are significantly positively correlated with CD4 + T lymphocyte count level. The monitoring of anti-HBs and the serum markers of HBV infection in the same individual is conducive to the in-depth understanding of the protective effect of anti-HBs and the scientific evaluation of the risk of infection after HBV exposure.

Clinical characteristics of 203 discharged patients with corona virus disease 2019 / 中华传染病杂志

Objective:To analyze the clinical data of 203 discharged patients with corona virus disease 2019(COVID-19), and to investigate the predictors for the severe cases.Methods:Confirmed COVID-19 cases hospitalized at Zhongnan Hospital of Wuhan University from January 1 to February 1, 2020 were consecutively enrolled, who were divided into severe group and non-severe group.The clinical data of enrolled patients were collected and the clinical manifestations, laboratory results, imaging, treatments and prognosis of patients in the two groups were analyzed. Mann-Whitney U rank sum test and chi-square test were used for statistical analysis. Results:A total of 203 discharged patients with COVID-19 were enrolled. The common clinical manifestations included fever (89.2%, 181/203), dry cough (60.1%, 122/203), chest distress (35.5%, 72/203), shortness of breath(29.1%, 59/203)and myalgia or arthralgia (26.6%, 54/203). The time from disease onset to hospital admission was 5.8 days (1.0 to 20.0 days). Among 203 enrolled patients, 107(52.7%) were divided into severe group and 96(47.3%) were non-severe group. The age in severe group was 60 years (23 to 91 years), which was significantly older than non-severe group (47 years (20 to 86 years)), the difference was statistically significant ( Z=-6.12, P<0.01). There were 63.6%(68/107) patients in severe group with at least one underlying disease, which was significantly more than non-severe group (20.8% (20/96)), the difference was statistically significant ( χ2=37.60, P<0.01). The proportions of patients with increased white blood cells, decreased lymphocytes and albumin, elevated alanine aminotransferase, aspartate aminotransferase, creatinine, lactic acid dehydrogenase, creatine kinase, fasting blood glucose, D-dimer, erythrocyte sedimentation rate, C-reactive protein, interleukin-6, and procalcitonin in severe group were all higher. On admission, 172 patients (84.7%) had bilateral patchy shadows or ground glass opacity in the lungs on chest imaging study, 20(9.9%) presented pleural effusion. Fifty-five cases (27.1%) showed progressions of lung lesions on computed tomography (CT) rescan at an average interval of five days. Among 203 patients, 123(60.6%) were given oxygen therapy upon admission, 107(52.7%) were given short-term glucocorticoid therapy, and 131(64.5%) received antiviral therapy; and 26(12.8%) died. The hospital stay was 11.0 days (1.0 to 45.0 days). Conclusions:Fever is the most common symptoms in COVID-19 patients.Elderly and patients with underlying diseases are risk factors for progression to severe cases. The elderly patients should be strengthened early monitoring, paid attention to the control of underlying diseases, and reduce the occurrence of critical diseases.

Manifestations of chest CT imaging in AIDS patients complicated with pulmonary cryptococcosis / 中华全科医师杂志

Objective@#To analysis the manifestations of chest CT imaging in acquired immunodeficiency syndrome (AIDS) patients complicated with pulmonary cryptococcosis.@*Methods@#The clinical data of 72 AIDS patients complicated with pulmonary cryptococcosis were analyzed retrospectively. There were 3 cases (4.2%) diagnosed with pulmonary cryptococcosis by biopsy, including 1 case of pulmonary cryptococcosis and 2 cases of disseminated cryptococcosis; 69 cases (95.8%) with pulmonary manifestations and clinically diagnosed with pulmonary cryptococcosis, including 43 cases of cryptococcal meningitis and 26 cases of disseminated cryptococcosis. The imaging features of chest CT, in terms of the morphology, size, number, distribution, internal features and margins of the lesions were analyzed.@*Results@#The chest CT findings were solid nodules or mass in 49 cases (68.1%), patchy shadows in 40 cases (55.6%), cavitary nodules or mass in 10 cases (13.9%), mediastinal and hilar lymph node enlargement in 17 cases (23.6%) and pleural effusion in 10 cases (13.9%).@*Conclusion@#The chest CT findings of AIDS patients complicated with pulmonary cryptococcosis mainly are multiple solid nodules or masses, patchy shadows and solitary cavitary pulmonary nodules or mass. For early diagnosis and treatment, cryptococcus screening should be performed in HIV-infected patients with pulmonary nodules or mass on chest CT.

Manifestations of chest CT imaging in AIDS patients complicated with pulmonary cryptococcosis / 中华全科医师杂志

Objective To analysis the manifestations of chest CT imaging in acquired immunodeficiency syndrome(AIDS) patients complicated with pulmonary cryptococcosis.Methods The clinical data of 72 AIDS patients complicated with pulmonary cryptococcosis were analyzed retrospectively.There were 3 cases (4.2％) diagnosed with pulmonary cryptococcosis by biopsy,including 1 case of pulmonary cryptococcosis and 2 cases of disseminated cryptococcosis;69 cases (95.8％) with pulmonary manifestations and clinically diagnosed with pulmonary cryptococcosis,including 43 cases of cryptococcal meningitis and 26 cases of disseminated cryptococcosis.The imaging features of chest CT,in terms of the morphology,size,number,distribution,internal features and margins of the lesions were analyzed.Results The chest CT findings were solid nodules or mass in 49 cases (68.1％),patchy shadows in 40 cases (55.6％),cavitary nodules or mass in 10 cases (13.9％),mediastinal and hilar lymph node enlargement in 17 cases (23.6％) and pleural effusion in 10 cases (13.9％).Conclusion The chest CT findings of AIDS patients complicated with pulmonary cryptococcosis mainly are multiple solid nodules or masses,patchy shadows and solitary cavitary pulmonary nodules or mass.For early diagnosis and treatment,cryptococcus screening should be performed in HIV-infected patients with pulmonary nodules or mass on chest CT.

Clinical features and risk factors of cytomegalovirus infection in AIDS patients / 中华临床感染病杂志

Objective To investigate the clinical features and risk factors of cytomegalovirus (CMV)infection in AIDS patients.Methods A total of 471 AIDS patients,including 173 with CMV infection and 298 without CMV infection were enrolled from Zhongnan Hospital of Wuhan University from June 2015 to August 2016.Multivariate Logistic regression was performed to analyze the risk factors for AIDS patients infected with CMV.Results Among 173 patients co-infected with CMV,103 (59.54%)were diagnosed as CMV viremia,70(40.46%)were CMV end-organ diseases (EOD),in which CMV pneumonia (n =33)and CMV retinitis (n =22)were the most frequent diseases.Univariate analysis showed that sexual transmission,low CD4 +T lymphocyte counts,first visit,tuberculosis,pneumococcal pneumonia (PCP), long hospital stay and septicemia were risk factors of cytomegalovirus infection among patients with AIDS (P <0.05).Multivariate Logistic regression analysis demonstrated that CD4 +T lymphocyte <50 cells/μL (OR =3.897,95%CI 2.354-6.453),concomitant tuberculosis(OR =4.619,95%CI 2.501 -8.529),PCP (OR =4.062,95%CI 2.345-7.038),sepsis (OR =2.553,95%CI 1 .098-5.936)were independent risk factors for CMV infection,while antiretroviral therapy (OR =0.559,95%CI 0.342-0.912)was a protective factor.Conclusions Hospitalized AIDS patients have a high incidence of CMV infection which has a tendency to induce multiple organ damage,and relevant risk factors should be avoid to accentuate disease as much as possible.

Clinical characteristics and prognosis of patients with acquired immune deficiency syndrome related lymphoma / 中华传染病杂志

Objective To explore the clinical characteristics, pathological features and prognostic factors of patients with acquired immune deficiency syndrome (AIDS) related lymphoma (ARL).Methods The clinical characteristics, treatment regimen and survival status were retrospectively analyzed.At a ratio of 1∶2, 106 general non-Hodgkin lymphoma (NHL) cases were included after matching for demography and clinical characteristics with 53 ARL patients.Chi-square test was used for statistical analysis.Overall survival was analyzed using Kaplan-Meier curves.Cox regression was used for multivariant analysis.Results The predominant pathologic type of ARL was diffuse large B cell lymphoma (60.4%, 32/53).B cell lymphoma accounted for 88.7% (47/53) and T cell lymphoma accounted for 11.3% (6/53).Patients in ARL group (62.3%, 33/53) had lower proportion of receiving radiotherapy or chemotherapy compared with patients in general NHL group (94.3%, 100/106) (χ2=26.58, P<0.05).ARL group had lower hepatitis B surface antigen (HBsAg) positivity rate compared with general NHL group (1.9% vs 26.4%, χ2=14.26, P<0.05).No other characteristic was found significantly different between these two groups.The survival time of ARL and general NHL patients was (6.0±1.3) months and (48.0±10.0) months, respectively (t=8.13, P<0.01).The 1-year, 2-year, 3-year and 5-year survival rates of ARL patients were 39.6%, 32.7%, 27.7% and 20.1%, respectively, while those of general NHL patients were 79.2%, 56.8%, 42.4% and 25.0%, respectively.Of the 33 ARL patients and 100 general NHL patients who received anti-NHL treatment, the 1-year survival rates were 60.6% and 83.0%, respectively (χ2=4.040, P=0.043), the 2-year survival rates were 53.5% and 60.5%, respectively (χ2=0.003, P=0.096), the 3-year survival rates were 48.1% and 45.9%, respectively (χ2=0.288, P=0.59), the 5-year survival rates were 39.1% and 27.5%, respectively (χ2=0.798, P=0.372).Multivariate analysis revealed that anti-NHL therapy and international prognostic index score were independent predictors for prognosis (both P<0.05).Conclusions Diffuse large B cell lymphoma is the predominant pathologic type of ARL.ARL patients has significantly lower survival rate compared with general NHL patients.Combination of anti-HIV therapy and anti-lymphoma therapy in individuals with ARL can prolong their survival time.

Clinicpathological features and survival of patients with AIDS related non-Hodgkin’s lymphoma / 中华血液学杂志

Objective@#To analyze the clinical characteristics, pathological features and survival of patients with AIDS related non-Hodgkin’s lymphoma (ARL) .@*Methods@#The clinical data of 53 ARL cases diagnosed and received care at Zhongnan hospital of Wuhan University were retrospectively studied, and 106 controls were enrolled as control group according to 1∶2 for paired cases and control. SPSS 13.0 package was used for statistical analysis. Kaplan-Meier was applied to assess the survival probability.@*Results@#The mean age of patients with ARL was 43 (11-67) years. Male versus female was approximately 4∶1. The median CD4+ T cell count was (146±20) /ml. The Ann Arbor clinical classification showed that 52.8% of the cases were of stage Ⅲ and Ⅳ. Approximately 54.7% of the patients had elevated serum lactate dehydrogenase (LDH) . According to international prognosis index score, 64.2% of the patients were in high risk group. Diffuse large B-cell lymphoma (DLBCL) was the predominant histological subtype. Among 53 cases, 33 cases (62.3%) received combination of anti-HIV therapy and anti-NHL (CHOP) chemotherapy regimen, 8 cases (15.1%) only received anti-HIV therapy, and 12 cases (22.6%) asked for alleviative treatment. Median survival time was (6.0±1.3) months for ARL cases versus (48.0±10.0) months for controls (P<0.05) . After eliminating cases who did not receive anti-lymphoma treatment, ARL cases showed a lower 1-year OS rates than control group (60.6% versus 83.0%) , but no difference about 2-, 3- and 5-year OS rates (53.5% versus 60.5%, 48.1% versus 45.9%, and 39.1% versus 27.5%, respectively) .@*Conclusions@#ARL is more common in young adults; one-year mortality rate is high. Anti-HIV therapy combined with anti-NHL therapy could significantly improve the prognosis of ARL patients. CHOP regimen may be more suitable for ARL patients.

Association of CD4 + T lymphocyte count with HBV replication and progression of liver diseases in patients infected with HIV and HBV / 中华全科医师杂志

The clinical data of 459 patients,who were first diagnosed as HIV/HBV co-infection from January 2007 to December 2013,were retrospectively analyzed.Among all patients,there were 89 cases with CD4 ＜ 50/μl,134 cases with CD4 50-200/μl and 236 cases with CD4 ＞ 200/μl,when HIV infection was diagnosed.In these three groups with different CD4 levels,the HBV DNA positive rates were 49.3％ (37/75),50.5％ (54/107) and 33.7％ (66/196);the HBV viral load were (6.37 ± 1.71) log10 copies/ml,(5.82 ± 1.86) log10 copies/ml and (4.36 ± 1.64) log10 copies/ml;the rates of abnormal liver function were 29.2％ (26/89),29.1％ (39/134) and 10.6％ (25/236);the occurrence rates of end-stage-liver-diseases were 16.9％ (15/89),14.9％ (20/134) and 5.1％ (12/236);the mortality rates were 10.1％ (9/89),9.7％ (13/134) and 3.8％ (9/236),respectively.The HBV DNA positive rates,HBV viral load,the rates of abnormal liver function,the occurrence rates of end-stage-liver-diseases and the mortality rates in CD4 ＞ 200/μl group were lower than that in CD4 ＜ 50/μl group and 50-200/μl group.The results suggest that for HIV and HBV co-infection patients,HBV replication level and prognosis of liver diseases are associated with CD4 + T lymphocyte count.

Analysis on sero-conversion status of human immunodeficiency virus-discordant spouse during 5-year follow-up period / 中华传染病杂志

Objective To investigate the influence of safe sex education and antiretroviral therapy (ART) on human immunodeficiency virus (HIV) antibody sero-conversion status among HIV-discordant spouses.Methods Totally 1 258 HIV/acquired immunodeficiency syndrome (AIDS) cases and their spouses were enrolled and the related information was collected during 2005 to 2007.The HIV negative spouses were tested for HIV antibody once every 6 months.The effects of safe sex education and ART on sero-conversion status of HIV-discordant spouses were analyzed.The date were analyzed by x2 test.Results Without any intervention,505 out of 1 258 HIV/AIDS spouses were positive for HIV test,with the HIV natural spousal transmission rate of 40.1％.Among 442 blood source and 816 sexual source index HIV cases,HIV was positive in 103 and 402 of their spouses,respectively,with the HIV transmission rates between couples of 23.3％ and 49.3 ％,respectively.HIV transmission rate in sexual source group was higher than that in blood source group (x2 =80.421,P＜0.01).Among 608 male and 650 female index HIV cases,HIV was positive in 333 and 172 of their spouses,respectively,with the HIV transmission rates between couples of 54.8％ and 26.5％,respectively.Rate of HIV transmission from men to women was higher than that from women to men (x2 =104.770,P＜0.01).Among 753 HIV discordant couples,only 5 spouses had HIV sero-conversion (0.7％) after comprehensive intervention measures during 5 years of follow-up period.Among 31 HIV/AIDS patients who were only accepted safe sex education,3 of their spouses were HIV positive (9.7％).The transmission rate was lower than that in patients without any intervention (40.1％) (x2 =11.760,P＜0.01).Among 722 HIV/AIDS patients received ART,2 of their spouses were HIV positive (0.3 ％),which was lower than the transmission rate (9.7％) in ART-na(i)ve group (x2=39.821,P＜0.01).Conclusion Safe sex education should be implemented throughout the health management of HIV/AIDS patients and their spouses.If possible,early ART should be carried out to reduce the risk of HIV transmission between married couples.

Impact of hepatitis B virus infection on efficacy of combined antiretroviral therapy in patients with acquired immunodeficiency syndrome / 中华传染病杂志

Objective To investigate the influence of hepatitis B virus (HBV) infection on efficacy of combined antiretroviral therapy (cART) in patients with acquired immunodeficiency syndrome (AIDS).Methods Seventy-eight subjects with human immunodeficiency virus (HIV)/HBV co-infection and 156 subjects with HIV mono-infection were included.CD4+ T cell count,HIV viral load,HBV-markers and liver functions were routinely tested.The differences in survival rate,as well as immunological and virological responses between the two groups (HIV/HBV co-infection group and HIV mono-infection group) during cART were compared.Categorical data were compared by Chisquare test,measurement data were compared by t test,and measurement data with abnormal distribution were compared by Mann-Whitney test.Results At month 42 of cART,HIV RNA levels and CD4+ T cell counts of the two groups were comparable.However,at month 48,54 and 60 of cART,the immunological and virological responses of HIV/HBV co-infection group were less favorable than those of HIV mono-infection group.At each time point of month 12,24,36,48 and 60 of cART,3 out of 13 subjects with HIV/HBV co-infection maintained hepatitis B e antigen (HBeAg)loss; the HBeAg seroconversion rates were 32.1％ (9/28),50.0％ (14/28),53.6％ (15/28),64.3％ (18/28) and 71.4％ (20/28),respectively (x2 =10.189,P=0.037) ; HBV DNA negative rates were 95.1％ (39/41),82.9％ (34/41),68.3％ (28/41),43.9％ (18/41) and 43.9％ (18/41),respectively (x2 =29.982,P=0.000); liver dysfunction rate was 32.1 ％ (25/78),51.4％ (38/74),33.8％ (22/65),47.9％ (23/48) and 6.7％ (3/45),respectively (x2 =28.053,P=0.000).Mortalities in HIV/HBV co-infected and HIV mono-infected individuals were 24.4％ (19/78) and 5.1 ％ (8/156),respectively (x2 =18.841,P＜0.01).Sixteen out of the 19 deaths (84.2 ％) in HIV/ HBV co-infected subjects died of end stage liver diseases.Conclusions HBV co-infection diminishes the long term efficacy of cART.End stage liver diseases are the primary cause of death in HIV/HBV co-infected subjects during cART.

Clinical features and treatment of hepatitis B virus and hepatitis C virus co-infection among patients with acquired immune deficiency syndrome / 中华传染病杂志

Objective To estimate the clinical features of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection among acquired immune deficiency syndrome (AIDS) patients and the interaction of lamivudine (3TC) contained antiretroviral therapy (ART) with hepatitis virus replication.Methods From 2004 to 2010,199 human immunodeficiency virus (HIV)/HBV coinfected patients admitted to Zhongnan Hospital of Wuhan University were enrolled,including 76 cases of HIV/HBV/HCV triple infection and 123 cases of HIV/HBV dual infection.Hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) were detected routinely.HBV DNA,HCV RNA before and after ART with 3TC and incidence of end-stage-liver-diseases in two groups were compared.Categorical data were analyzed by chi-square test,and measurement data were compared by t test.Results Positive rates of HBV DNA in HIV/HBV and HIV/HBV/HCV coinfection group before treatment were 45.5 ％ (56/123) and 25.0 ％ (19/76),respectively (x2 =8.429,P=0.004).The levels of HBV DNA in the two groups before treatment were (5.61±1.88) lg copy/mL and (4.70±1.84) lg copy/mL,respectively (t=2.589,P=0.003).After ART with 3TC,detectable rate of HBV DNA in HIV/HBV/HCV group decreased to 9.2％ (7/76),which was significantly lower than pretreatment (x2 =6.681,P=0.010),but serum HCV RNA increased significantly from 56.6％ (43/76) pretreatment to 72.4％ (55/76) post-treatment (x2 =4.136,P=0.042).The incidence of end-stage-liver-diseases in HIV/HBV/HCV co-infected group was significantly lower than that of HIV/HBV dual infection group (18.8 per 1000 person years vs 42.1 per 1000 person years; x2 =4.459,P =0.035) during an average of 5.6 years of follow up.Conclusion It is possible that there are interactions between HBV and HCV when the two viruses are co infected.The timing of patient enrollment might be an impact factor on study results.

Prevalence and risk factors of end-stage liver disease in a cohort of human immunodeficiency virus and hepatitis C virus co-infected patients treated with antiretroviral therapy / 中华传染病杂志

Objective To investigate the incidence and risk factors of end-stage liver disease (ESLD) in human immunodeficiency virus (HIV) and hepatitis C virus (HCV) co-infected patients after antiretroviral therapy (ART).Methods The demographic and clinical data of HIV-HCV coinfected patients in Zhongnan Hospital,Wuhan University and local Centers for Disease Control and Prevention (CDC) from Jan 2003 to Dec 2010 were analyzed retrospectively. Single factor and multiple factor Logistic regression were used to analyze the correlation between the variables and incidence of ESLD,such as baseline age ≥40,male,previous blood transfusion history,duration of HCV persistent infection,hepatitis B virus (HBV) co-infection (HBsAg positive),HIV RNA≥-1 ×104 copy/mL at last visit,HCV RNA≥ 1.× 105 copy/mL at last visit,CD4 count ＞ 200 / μL at last visit,alanine aminotranferase (ALT) ≥ 2 × upper limit normal (ULN) at last visit,ART containing nevirapine (NVP),follow-up duration,ART duration＞5 years and HCV genotype 1b.The effect of ESLD on the survival of HIV-HCV co-infected patients was analyzed by Kaplan-Meier method.Results Totally 427 HIV-HCV co-infected patients were followed up with average of 3.7 years. Fifty-five patients (12.9％) developed ESLD,and 52 patients (12.2％) died.Factors independently associated with ESLD included baseline age≥40 (OR=2.385,P=0.039),ALT ≥2× ULN (OR=16.374,P=0.000),HBV-coinfection (OR=2.507,P=0.042),duration of ART ＞ 5 years (OR=3.232,P=0.010),and CD4 count ≥200/μL (OR=0.364,P=0.011).The cumulative mortality of HIV-HCV co-infected patients with ESLD was 50.9％,whereas that of HIV-HCV co-infected patients without ESLD was 6.5％ (P=0.000).Conclusion In the ART era,ESLD is common among HIV-HCV co-infected patients in China,which is responsible for reducing the survival time of the patients.

Risk factors of death in HIV/HCV co-infected patients with combined antiretroviral therapy / 中华临床感染病杂志

Objective To analyze the incidence,mortality and risk factors of death in human immunodeficiency virus (HIV) and hepatitis C virus (HCV) co-infected patients with combined antiretroviral therapy (cART).Methods A total of 427 HIV/HCV co-infected patients admitted to Zhongnan Hospital of Wuhan University or local disease prevention and control canters from January 2003 to December 2010 were enrolled in the study.The demographic and clinical data of patients were retrospectively studied.Cox progressive regression model was used for data analysis,and Kaplan-Meier method was used to evaluate the effect of end-stage liver diseases on the death.Results of 427 HIV/HCV co-infected patients,53 ( 12.4％ ) died during the follow-up,in which 28 (52.8％) died of liver-related diseases.Male gender ( RR =2.63,P =0.05 ),infection via blood transfusion ( RR =2.15,P =0.04),baseline CD4 + T cells ＜50 cells/μL ( RR =2.83,P =0.02),HIV RNA≥ 104copies/mL at the end of follow-up (RR =2.79,P =0.00 ) and complicated with end-stage liver disease ( RR =7.79,P =0.00) were significantly related to the death.Duration of cART ＞ 5 years is a protective factor for the death ( RR =0.03,P =0.00).Themortality of patients complicated with end-stage liver diseases was 52.7％ ( 29/55 ).Conclusion Liver disease-related death has become the leading cause of death in HIV/HCV co-infected patients,and patients with end-stage liver diseases are of high risk of death.

Epidemiology and distribution of hepatitis C virus genotype among HIV positive former blood donors and transfusion recipients in Hubei province / 中华全科医师杂志

ObjectiveTo explore the epidemiologic features and distribution pattems of hepatitis C virus (HCV) genotype infection among HIV positive former blood donors (FBDs) and transfusion recipients in Hubei province.Methods597 serum samples from HIV-positive patients in Hubei were collected and examined for anti-HCV by enzyme-linked immunosorbent assay ( ELISA ).Reverse transcription nested polymerase chain reaction (RT-nested PCR) amplification and DNA sequencing were used to evaluate the HCV core regions.ResultsThe prevalence rates of HCV in HIV positive FBDs and transfusion recipients were 76.5％ (205/268) and 57.4％ (189/329) respectively.HCV genotypes 1b (92.8％,90/97) and 2a (7.2％,7/97 ) were detected.ConclusionsBlood donation and blood transfusion are the major modes of HIV-HCV co-infection in Hubei province.The prevalence of HCV in HIV positive transfusion recipients is lower than that in HIV positive FBDs.HCV genotypes 1b and 2a are the predominant strains among HIV-positive FBDs and transfusion recipients.

Logistic regression analysis for risk factors related to end-stage liver disease among HIV/HBV co-infection patients / 中华全科医师杂志

Objective To understand major risk factors associated with end-stage liver disease (ESLD) among patients with human immunedeficiency virus (HIV)/hepatitis B virus (HBV) co-infection.Methods Patients with HIV/HBV co-infection were followed-up and factors related to ESLD were analyzed using logistic regression model to estimate odds ratios (ORs) for them. Results A total of 255 patients with HIV/HBV co-infection were investigated, with an incidence of ESLD of 19. 2% ( 49/255 ). Major risk factors associated with ESLD among patients with HIV/HBV co-infection included count of CD4 below 200 cells/μl at baseline, HIV RNA load decreasing to the lower limit of its detection level within six months after antiretroviral treatment (ART), abnormal of serum activities of transaminase (ALT or AST), longer persistently positive of HIV RNA and HBV DNA, and use of lamivudine-based ART, with OR of 6. 503,14. 456, 0. 049, 1. 814, 1. 536 and 0. 012, respectively. Conclusions Lower CD4 count, abnormal serum transaminases, persistent replication of HIV and HBV all are closely related to ESLD in patients with HIV/HBV co-infection. Therefore, lamivudine-based ART should be of choice for patients with HIV/HBV coinfection to decrease incidence of ESLD.