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Research Of Human Immunodeficiency Virus/AIDS And Hepatitis B Virus Co-infection In Some Areas Of Yunnan Province

Posted on:2012-07-29Degree:MasterType:Thesis
Country:ChinaCandidate:Q LanFull Text:PDF
GTID:2154330335960926Subject:Internal Medicine
Abstract/Summary:PDF Full Text Request
Background:At present, HIV/AIDS patients increased much more rapid than before. At the same time, China, a country of high incidence of HBV infection, has half of the patients all over the world. Obviously, studies focused on the situation of HIV/HBV co-infection and the effect of Highly Active Antiretroviral Therapy (HAART) are very significant and will affect the diagnosis and treatment of AIDS patients greatly.Objective:This study includes three parts, which are partⅠto study the prevalence of HIV/AIDS patients co-infected with HBV in some areas of Yunnan Province, partⅡto analyze the correlation between hepatitis B virus DNA (HBV-DNA) and serological markers of hepatitis B virus (HBV-M) in HIV/HBV co-infected patients, partⅢto investigate the YMDD mutation induced by Lamivudine as a component of HAART and the associated factors of mutation in HIV/HBV co-infected patients.Methods:PartⅠ:Collecting clinical datas of 112 HIV/HBV co-infected patients in 2 cities of high AIDS incidence (Luxi City, Kunming) in Yunnan province.PartⅡ:In sera of 64 patients co-infected with HIV/HBV, HBV-M was detected by time-resolved fluorescence immunoassay (TRFIA), and HBV-DNA level was detected by fluorescence quantitative polymerase chain reaction (FQ PCR).PartⅢ:Testing the YMDD sequence of hepatitis B virus in 64 HIV/HBV co-infected patients by direct sequencing.Results: Part I:1.112 patients infected by HIV/HBV (89 male,23 female) were included in our study, whose mean age was 42.15±10.02 years (rang:23-76 years). The rate of HIV/HBV co-infection was 4.2% in some areas of Yunnan. Sexual transmission was the main route of transmission of HIV, accounted for 55.4%(62/112).2. Comparison of HIV/HBV co-infected patients in Luxi and Kunming, most of whom were married and middle-aged men, primary to secondary education, shows that there was no significant difference between the two cities (P1=0.903; P2=0.971; P3=0.766; P4=0.168). Luxi minority infected patients were significantly more and sexual transmission were higher than those of Kunming (P1=0.001; P2=0.03).3. There existed significantly different routes of transmission in different infection model. Sexual transmission was the main route in HIV/HBV co-infection model and intravenous drug use was the main route in HIV/HBV/HCV co-infection model (P=0.00).PartⅡ:1. For HIV/HBV co-infected patients under HAART, HBV's replication has no relevance with the general situations of the patients (P>0.05).2. HBV-DNA positive rates of HBsAg+HBeAg+HBcAb group and HBsAg+HBeAg group were respectively 70.59% and 100%, which were significantly higher than those of other hepatitis B virus serological patterns (P<0.05). HBV-DNA positive rate of HBeAg-positive group was also significantly higher than that of HBeAg-negative group (P<0.05).3. In the overall, there existed difference of the HBsAg content in different levels of HBV-DNA. Pairwise comparison showed that HBsAg content was significantly different between 3>HBV-DNA group and 5=HBV-DNA. HBsAg level in the group of high viral replication was significantly higher than that in the HBV-DNA negative group (P<0.05), while there was no significant difference of the HBsAg content between the middle and low HBV-DNA levels(P> 0.05). Similarly, the level of HBsAg was different in the overall in different hepatitis B virus serological patterns. By pairwise comparison, it was found that the HBsAg level in HBsAg+HBeAg+HBcAb group was significantly higher than that of the HBsAg+HBeAb+HBcAb group (P<0.05), while there were no significant differences between other patterns. Through linear regression analysis, it was found that HBV-DNA exists positive correlation with HBsAg (regression coefficient=0.244>0)., HBV-DNA positive appears when HBsAg> 3.241gng/ml.Part III:1. From 20 blood samples of HIV/HBV co-infected patients,8 HBV YMDD mutations were detected. The rate of YMDD mutations was 40%(8/20), in which YIDD was 2 (25%,2/8) and YVDD 6 (75%,6/20), both with rtL180M site mutation. It was found that YMDD variants had several high-frequency variation sites: rtY221F, rtT222A, rtV224I, rtN238H, rtI269L etc.7 cases accompanied Y221F+V224I+N238+I269L mutation in the YI/VDD+L180M mutations, the detection rate of which was 87.5%(7/8).2. Among those HIV/HBV co-infected patients, the antiviral treatment duration of the YMDD mutation group was significantly longer than that of the group without mutation (P<0.05), while the social demographic characteristics, routes of transmission of HIV, duration of HIV infection, liver function (ALT, AST) and immune status (CD4, CD8) at baseline, status of HCV, HBV-DNA level, or liver function and immune status at time of the last consultation were of no significant difference between the two groups (P>0.05).Conclusion:PartⅠ:1. With an infection rate of 4.2%, HIV/HBV co-infection patients are common in some areas of Yunnan, so we should provide conventional detection for those HIV patients and take active measures related to prevention and treatment of hepatitis virus.2. There is little social demography difference of HIV/HBV co-infection between Luxi and Kunming city.3. Different infection model has different route of transmission. Intravenous drug use was the main route of HIV/HBV/HCV co-infection model. HCV should be the key indicator of intravenous drug users, especially for HIV-positive patients. Part II:1. HBV replication has no relevance with the general situation of HIV/HBV co-infection patients.2. HBeAg indicates the activity of replication of HBV in HIV/HBV co-infected patients. However, we should detect the HBV-DNA level to assess the patient's condition and detect the variation of the former C during the clinical diagnosis and treatment.3. The content of HBsAg is much more related to the replication level of HBV-DNA in HIV/HBV co-infected patients. However, we should combine the clinical feature with the quantity of HBV-DNA to evaluate the patient's condition and treatment.Part III:1. The rate of YMDD mutation is much higher in HIV/HBV co-infection patients, while the types of variation are more complex.2. The drug resistance increase followed with the HAART containing 3TC for YMDD mutation, thus we should give a dynamic monitoring of YMDD variation, which helps to adjust the treatment in time.3. YMDD mutation is not clear on the course of disease, but we should observe the liver function closely and strengthen the corresponding protective treatment timely.
Keywords/Search Tags:Yunnan, HIV/HBV co-infection, HBV-DNA, HBV serological markers, Lamivudine, YMDD mutation
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