论文摘要:
研究人员对5个中心的hbv/hiv患者的肝组织进行回顾性分析
最终纳入53例患者,平均年龄为42岁,96%为男性,30%为非裔美国人,66%应用了art,绝大多数(95%)都检测不到hiv rna62%的患者e抗原阳性,35%的患者hbv dna<1000 u/l,30%检测不到hbv dna6%的测试者抗-hdv(n=30)呈阳性alt:52 u/l,ast:57 u/l,cd4:420肝组织学显示31例患者有晚期肝纤维化(58%)相比那些轻微疾病的患者,有进展性肝纤维化的患者更有可能使用了art,有一个较低的cd4最低点(p=0.04)和较高的ast(p=0.08)就hbeag状态或hdv存在而言,群组之间没有差异在现有数据的子集中(n=46),hbvd na<1000 iu/ml与疾病的严重程度不相关对于鉴别晚期肝纤维化与轻怎样抗肝纤维化微疾病,fib-4表现略优于apri[aurocs 0.78(95% ci 0.71-0.85)和0.68(95%ci 0.48-089)]
background: despite the widespread use of anti-retroviral therapy (art) active against both hiv and hbv, liver-related mortality remains high among hiv infected persons. liver biopsy is rarely performed in the setting of suppressed hbvdna, yet co- infected indi治肝纤维化的药viduals were at risk of developing liver injury for many years prior to treatment initiation. we sought to better define the spectrum of histologic liver disease, and correlates of liver disease, in hbv–hiv co-infection.
methods: a retrospective analysis of liver histology in hbv–hiv patien肝纤维化诊断标准ts from 5 centers was performed. those with decompensation, hcv or other liver disease were excluded. liver biopsy results and demographic and clinical data obtained at the time of the biopsy were recorded. predictors of fibrosis (comparing those with bridging fibrosis/cirrhosis to those with stage 0&nd肝纤维化原因ash;2 fibrosis) were assessed.
conclusions: a high proportion of hbv–hiv co-infected patients have advanced fibrosis despite hbv suppression. those on art appear to have more advanced liver disease, and this may have masked any benefit associated with hbv treatment. larger, welldesigned studies of治肝纤维化的中药 liver histology and its correlates are needed to better define the spectrum of liver disease in this understudied population.
results: fifty-three patients were included. the mean age was 42, 96% were male, 30% were african american, 66% were on art and the vast majority (95%) had undetectable hiv rna. 62% were eag+, 肝纤维化病理35% had hbvdna
liver disease in hbv–hiv co-infection: significant fibrosis is present despite hbv suppression with anti-retroviral therapy
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hbv–hiv合并感染病人晚期肝纤维化的比例高,尽管hbv病毒得到抑制使用了art疗法的患者更易出现肝脏疾病,这可能掩盖了与hbv治疗相关的任何益处需要更大的,设计良好的肝组织学及其相关因素的研究,来更好地确定这些缺乏研究的人群的肝脏疾病谱
尽管通过现有的药物可以使乙型肝炎病毒得到抑制,但许多同时感染hbv和艾滋病(hiv)的患者出现进展性肝纤维化,根据2013年欧洲肝病学会(european association for the study of the liver,easl)主办的国际肝病大会上一项新的研究报告显示
抗逆转录病毒疗法(art)广泛应肝纤维化怎么查用于抗hiv和hbv,但在hiv感染者中,肝脏相关死亡率仍然很高肝活检很少在hbv dna已得到抑制后进行,然而,合并感染者在治疗开始之前的很多年里已处于肝损伤发展的风险中
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