To investigate the clinical characteristics of patients with human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) combined with hepatitis B virus (HBV) and (or) hepatitis C virus (HCV) infection.

Clinical data of 8 369 patients with HIV/AIDS hospitalized in Nanning Fourth People’s Hospital from January 2014 to December 2017 were collected, including the incidence rates of HIV/AIDS combined with HBV and (or) HCV co-infection and severe liver disease, HIV RNA load, CD4⁺ T cell count, fatality rate and occupation, ethnic distribution, et al. Among whom, 2 145 cases were female and 6 224 cases were male. Total of 3 220 cases were with complete clinical data and all tested for HIV RNA and T lymphocyte subsets. The cases with co-infection were divided into HIV/HBV group (317 cases), HIV/HCV group (326 cases), HIV/HBV/HCV group (39 cases) and HIV/AIDS group (2 538 cases). HIV RNA for the overall comparison of groups were analyzed by ANOVA, and for every two groups were compared by LSD-t test, indicators of cell immune function (CD4⁺ T and CD8⁺ T) were analyzed by rank sum test of non-parametric, and rates of incidence and fatality of severe liver disease were analyzed by Chi-square test.

The rates of HBV infection, current HCV infection, liver cirrhosis, hepatocellular carcinoma and liver failure of patients with HIV/AIDS were 4.90% (410/8 369), 5.07% (424/8 369), 13.98% (1 170/8 369), 0.32% (27/8 369) and 0.44% (37/8 369), respectively. The top three ethnic distribution of patients with HIV/AIDS combined with HBV and (or) HCV infection were 11.74% (254/2 164) for Zhuang nationality, 8.67% (522/6 021) for Han nationality, and 4.29% (6/140) for Yao nationality; the top three occupational distribution were 15.42% (218/1 414) for unemployed, 12.34% (84/681) for freelance and 12.2% (5/41) for commercial attendants. The HIV RNA load of patients in HIV/HBV group, HIV/HCV group and HIV/HBV/HCV group were (5.51 ± 0.22) log₁₀copies/ml, (5.31 ± 0.23) log₁₀copies/ml and (5.04 ±0.12) log₁₀copies/ml, respectively, which were significantly higher than that of HIV/AIDS group [(4.02 ± 0.20) log₁₀copies/ml] (t = 123.633, 107.676, 31.758, all P < 0.001). The median CD4⁺ T cell count of patients in HIV/HBV group, HIV/HCV group and HIV/HBV/HCV group were 10.85 (65.36, 150.78) cells/μl, 232.47 (178.56, 277.98) cells/μl and 152.69 (101.25, 200.35) cells/μl, respectively, which were significantly lower than that of HIV/AIDS group [(278.35 (231.65, 325.74) cells/μl] (Z = 24.400, 8.284 and 8.046, all P < 0.001). The median CD8⁺ T cell count of patients in the above groups were 387.25 (285.45, 452.35) cells/μl, 654.23 (412.87, 798.56) cells/μl and 545.87 (301.95, 654.56) cells/μl, respectively, which were significantly lower than that of HIV/AIDS group[725.14 (500.47, 879.89) cells/μl] (Z = 18.560, 3.142, 5.754, all P < 0.001). The median CD8⁺ T cells were compared between HIV/HCV group and HIV/HBV group [654.23 (412.87, 798.56) cells/μl vs. 387.25 (285.45, 452.35) cells/μl; Z = 13.250, P < 0.001], HBV/HIV group and HIV/HCV/HBV group [387.25 (285.45, 452.35) cells/μl 545.87 (301.95, 654.56) cells/μl; Z = 3.235, P < 0.001], all with significant differences. There were also significant differences in the median counts of CD4⁺ T cells between HIV/HCV group and HIV/HBV group [232.47 (178.56, 277.98) cells/μl vs. 110.85 (65.36, 150.78) cells/μl; Z = 16.117, P < 0.001], HIV/HBV group and HIV/HCV/HBV group [110.85 (65.36, 150.78) cells/μl vs. 152.69 (101.25, 200.35) cells/μl, Z = 24.400, P < 0.001], HIV/HCV group and HIV/HBV/HCV group [232.47 (178.56, 277.98) cells/μl vs.152.69 (101.25, 200.35) cells/μl; Z = 5.810, P < 0.001]. The rates of severe liver diseases (including liver cirrhosis, hepatocellular carcinoma and liver failure) of patients in HIV/HBV group, HIV/HCV group and HIV/HBV/HCV group were 14.44% (53/367) (χ² = 500.40, P < 0.001), 13.91% (53/381) (χ² = 510.42, P < 0.001) and 62.79% (27/43) (Fisher’s exact test: P < 0.001), respectively, which were significantly different from that of HIV/AIDS group [ (48/7 578, 0.01%)] (χ² = 500.40, 510.42, 1695.28; all P < 0.001); and there was significant difference in overall comparison of the four groups (χ² = 648.84, P < 0.001). The total mortality of enrolled patients was 8.09% (677/8 369), and the mortality of HIV/HBV group, HIV/HCV group and HIV/HBV/HCV group were 2.1% (11/367), 3.15% (12/381) and 13.95% (6/43), respectively, which were significantly different compared with that of HIV/AIDS group (5/7 578, 0.07%) (Fisher’s exact test: all P < 0.001), and there was significant difference in overall comparison of the four groups (χ² = 348.48, P < 0.001).

Patients with AIDS in our hospital, especially Zhuang and Han nationality, the unemployed, freelancers had high co-infection rate of HBV and (or) HCV, which may increase HIV RNA replication, cause severer decrease in cellular immune function, result in increased incidence of severe liver diseases such as liver cirrhosis, hepatocellular carcinoma and liver failure.