【摘要】 目的分析HIV/AIDS患者合并HBV、HCV感染的流行特征和影响因素,为制定防治措施提供依据。方法调查武汉市HIV/AIDS患者队列相关信息和HBV、HCV感染状况,运用卡方检验、非条件Logistic回归模型、Kaplan-Meier生存分析等方法对HIV合并HBV、HCV感染的流行特征和影响因素进行分析。结果 2615例HIV/AIDS患者纳入研究,其中,男性占90.2%,未婚占52.9%,平均年龄(37.1±13.9)岁,感染途径以男男同性传播为主,占68.1%;HIV合并HBV/HCV感染呈逐年增加态势,HIV-HBV、HIV-HCV、HIV-HBV-HCV合并感染率分别为9.6%(251/2615)、4.5%(117/2615)、0.6%(16/2615);HIV-HBV合并感染的主要影响因素包括年龄(≥50岁与<25岁比较,OR=2.067,95%CI:1.172～3.644)、婚姻(已婚与未婚比较,OR=1.480,95%CI:1.007～2.177,离异或丧偶与未婚比较,OR=1.554,95%CI:1.077～2.243)、近3个月性行为是否用安全套(未用者与使用者比较,OR=1.922,95%CI:1.045～3.535),HIV-HCV合并感染的主要影响因素为感染途径(注射吸毒与同性传播比较,OR=53.985,95%CI:24.704～117.972)和HIV确证至抗病毒治疗(ART)间隔天数(>360 d与≤90 d比较,OR=1.754,95%CI:1.058～2.907);HIV合并HBV/HCV感染者抗病毒治疗后5年生存率小于无合并肝炎病毒感染者(Log Rankχ~2=11.947,P=0.008)。结论≥50岁、离异/丧偶、已婚男性以及无保护性行为、注射吸毒行为和延迟治疗,HIV/AIDS合并HBV/HCV感染的风险较高,针对性地预防干预、早期HBV/HCV筛查和个体化的ART提供可作为防治合并感染的重要措施。更多还原

【Abstract】 Objective To analyze epidemiological characteristics and influencing factors of hepatitis B virus(HBV)and hepatitis C virus(HCV)coinfection among patients with HIV/AIDS in Wuhan city,and provide information for the measures of HIV/AIDS prevention and control.Methods The data of HIV/AIDS cohort in Wuhan city was collected,including information of sociodemographics,behavioristics and ART etc.,and results of serological tests for HBV and HCV.The χ~2 test,unconditional logistic regression models and Kaplan-Meier survival analysis were used to identify the epidemiological characteristics and influencing factors.Results A total of 2615 patients with HIV/AIDS were included in the study.Of them,90.2% were male,52.9% were unmarried,and the average age were(37.1±13.9).HIV infections mainly transmitted via men who have sex with men(MSM),accounting for 68.1%.The prevalence of HBV/HCV coinfection was increasing,and the prevalent rate was 9.6%(251/2615) for HIV-HBV,4.5%(117/2615) for HIV-HCV,0.6%(16/2615)for HIV-HBV-HCV,respectively.Significant predictors of HIV-HBV coinfection included age(≥50 years vs.<25 years,OR=2.067,95%CI:1.172-3.644),marriage status(married vs.unmarried,OR=1.480,95%CI:1.007-2.177,divorced or widowed vs.unmarried,OR=1.554,95%CI:1.077-2.243)and unprotected sexual behavior(condom not used vs.condom used,OR=1.922,95%CI:1.045-3.535),and transmission mode(injection drug use vs.MSM,OR=53.985,95%CI:24.704-117.972)and time interval from HIV confirmation to ART initiation(>360 days vs.≤90 days,OR=1.754,95%CI:1.058-2.907)were verified as significant predictors of HIV-HCV coinfection.The five year survival rate of HIV/AIDS patients with coinfection of HBV/HCV after ART treatment was lower than that of the patients with single-HIV infection(Log Rank χ~2=11.947,P=0.008).Conclusion There were higher risks to HBV/HCV coinfections in HIV/AIDS who were 50 years or older,widowed or divorced or married,and with unprotected sexual behavior,injection drug used and delayed ART.Targeted preventive interventions,early screening of HBV/HCV and individualized ART provision might be used as key measures for HBV/HCV coninfections prevention and control.更多还原