A Clinical Study About Human Immunodeficiency Virus And Hepatitis C Virus Coinfection

l.The epidemiological investigation of HIV、HCV among differentpopulation Objective:To investigate the epidemic of HIV or HCV in China, and to develop reasonable measures to control HIV and HCV transmission, we measured anti-HCV and anti-HIV test in different group people by enzyme linked immunosorbent assay (ELISA). Methods:Our study population divided into general people and high-risk people. The general person was young adults for ante marital examination or pregnancy testing in different project areas. The high-risk people including of the past paid blood donors (PBD), blood recipients (BR), intravenous drug user (IDU). Results:A total46891general cases for anti-HIV,577cases were positive (1.23%). A total24532general cases for anti-HCV,450cases were positive (1.23%). The prevalence of anti-HCV and anti-HIV was significantly different in different areas, and the prevalence among male was higher than female. The prevalence of anti-HCV and anti-HIV among high-risk people was61.7%(673/1090),34.3%(399/1163) respectively. The prevalence of HCV among HIV positive PBDs, BRs, IDUs, heterosexual and hotosexual transmission persons was80.2%(595/742),56.3%(218/387),76.5%(179/234),8.6%(117/1360),3.1%(5/161), respectively. In this study,76.8%patients infected with HIV subtype B’, and81.1%were infected with HCV subtype lb. Conclusions:In general, the prevalence of HIV or HCV is low in China, and is high in some local regions. Blood transmission is the main route of HIV/HCV co-infection. HIV or HCV positive person each other is high-risk groups in HIV epidemic areas main via blood transmission. The prevalence of HIV and HCV genotype were diversity and complexity. HIV/HCV genotypes are tightly linked to the mode of transmission rather than geographic proximity. 2. Influence of Hepatitis C Virus Infection on HIV-1Disease Progression and Response to Combine Antiretroviral TherapyBackground:Hepatitis C virus (HCV) infection is highly prevalent among HIV-1-infected individuals, but its contribution to the morbidity and mortality of coinfected patients who receive potent antiretroviral therapy is controversial. We used data from multicentre HIV Cohort Study to analyses clinical progression of HIV-1, and the virological and immunological response to combine antiretroviral therapy(cART) in HIV-1-infected patients with or without HCV infection. Methods: We analysed retrospective data on survival, clinical disease progression, suppression of HIV-1replication, CD4-cell recovery in antiretroviral therapy according to HCV status in745patients with first starting cART.Results:417patients (56.0%) were coinfected with HCV,303of whom (72.7%) had a history of blood transfusion or form paid donor,85of whom (20.3%) had a history of intravenous drug use. Virological response to antiretroviral therapy was similar between two groups. With the prolong time of cART, CD4-cell both was gradually increased between two groups. In contrast, HCV seropositivity was associated with a smaller CD4-cell recovery. No association between an increased incidence of acquired immunodeficiency syndrome-defining illnesses or death and HCV serostatus. However, there was a large increase in the incidence of liver disease-related deaths in HCV-seropositive patientsConclusions:The overall virological and immunologic responses to cART were not affected by HCV serostatus. HCV serostatus did not affect the risk of HIV-1disease progression, but the risk of liver disease-related deaths was markedly increased in HCV-seropositive patients.3、The Effect of HIV Coinfection on the Progression of HCV Infection and Anti-HCV TherapyObjectives:This study was conducted to determine whether HIV coinfection increases the risk of cirrhosis, hepatocellular carcinoma and death in HCV-infected patients in the cART eras. To provide information about the incidence, mortality and risk factors of end-stage liver disease (ESLD) in human immunodeficiency virus (HIV) and hepatitis C virus (HCV) co-infected patients. To study the safety and efficacy of peginterferon alfa-2a plus ribavirin vs standard interferon alfa-2b plus ribavirin in HIV-HCV coinfected patients. Methods:This retrospective cohort study was conducted among HCV-infected patients. Incidence rates, cumulative incidence, and Cox proportional hazard ratios were calculated. Results:The cumulative incidence of ESLD was5.2%(7/134) in HCV positive patients and12.7%(29/229) in HIV/HCV coinfected patients (P=0.022). The hepatocellular carcinoma and death rate of HIV-infected patients with cirrhosis in the cART era was22.2%(14/63) and57.1%(36/63), both was higher than those in HIV negative compensated cirrhosis (P=0.000). The mean survival was65.4±5.5months in HIV-decompensate cirrhosis patients and was14.9±1.4months in HIV coinfected patients(P=0.000),but median survival was similar (6.3vs4.9months,P>0.05). Of427HIV-HCV coinfected patients with a median follow-up of3.7years,55patients (12.9%) developed ESLD, and52patients (12.2%) died. Older age at baseline (OR=2.385,P=0.039), alanine aminotranferase (ALT)>2up limit normal (ULN) at end of follow-up (OR=16.374, P=0.000), HBV-coinfection (OR=2.507, P-0.042), CDC stage C (OR=10.472, P=0.000), duration of cART>5years (OR=3.232, P=0.010), and CD4count at end of follow-up≥200cells/mm3(OR=0.364, P=0.011) were independently associated with ESLD. A total of76patients were enrolled for anti-HCV therapy,53patients with HIV coinfection;25coinfected patients received peginterferon alfa-2a plus ribavirin treatment and28received interferon alfa-2b plus ribavirin for48weeks. The sustained virological responses was similar between with or without HIV infection (64.7%,73.3%, respectively).The SVR was also similar between peg-IFN and IFN plus RBV. Zidovudine increased anaemia among HIV-HCV coinfected patients.Conclusions:HIV infection accelerates HCV-related disease progression and mortality. In the cART era, ESLD was common among HIV-HCV coinfected patients in China. ESLD shorten the survival of patients with HIV-HCV coinfection. In combination with ribavirin, treatment with peginterferon alfa-2a or standard interferon alfa-2b is similar effective for HCV infection in HIV-infected patients.4、Impact of IL28B polymorphism and HIV coinfection on the spontaneous clearance of hepatitis CObjective:The aim of this study was to evaluated the association between of SNP rs12979860of the IL28B gene and spontaneous clearance of HCV infection in paid blood donors or blood recipients in China. Methods:The SNP was analyzed by polymerase chain reaction (PCR) followed by DNA sequencing. Logistic regression was used to examine sociodemographic, behavioral, clinical, viral and host determinants, measured around acute infection, of HCV clearance. Result:A total656anti-HCV-positive patients, spontaneous clearance was observed in159subjects (24.2%). In multivariate analysis, rsl2979860(CC) and Chronic Hepatitis B infection were significantly associated with spontaneous clearance. HIV coinfection didn’t associated with HCV spontaneously clear. Conclusion:The rs12979860polymorphism and HBV coinfecion is associated with spontaneous clearance of HCV.