Fang Chi-Tai, Chen Pei-Jer, Chen Mao-Yuan, Hung Chien-Ching, Chang Shan-Chwen, Chang An-Lung, Chen Ding-Shinn
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
J Hepatol. 2003 Dec;39(6):1028-35. doi: 10.1016/s0168-8278(03)00416-1.
BACKGROUND/AIMS: The optimal strategy to prescribe highly active antiretroviral therapy (HAART) in patients infected with both hepatitis B virus (HBV) and human immunodeficiency virus (HIV) remains unsettled. This study aimed to compare the HBV dynamics between HBeAg-positive and HBeAg-negative coinfected patients treated with lamivudine-containing HAART.
We retrospectively analyzed the serial changes of plasma HBV DNA levels in 24 HBsAg-positive HIV-infected patients who entered the HAART program. A polymerase chain reaction-based assay, capable of quantifying as few as 400 HBV copies/ml, was used. The median follow-up time was 18 months.
HAART containing lamivudine 300 mg/day effectively suppressed plasma HBV-DNA to 10(-3)-10(-5)-fold of the baseline levels, but a multi-phasic decay of HBV DNA was observed. The later phases became flat, as a persistent residual HBV viremia, in eight of the studied 10 HBeAg-positive patients; in contrast, residual HBV viremia was not observed in the 10 HBeAg-negative patients studied (8/10 vs. 0/10, P=0.0007, Fisher's exact test). HAART without lamivudine did not suppress plasma HBV DNA levels in the remaining four patients.
HAART containing lamivudine 300 mg/day effectively suppress HBV replication in HBeAg-negative HIV/HBV-coinfected patients. Nevertheless, residual HBV replication persisted in most HBeAg-positive coinfected patients.
背景/目的：对于同时感染乙肝病毒（HBV）和人类免疫缺陷病毒（HIV）的患者，开具高效抗逆转录病毒治疗（HAART）的最佳策略仍未确定。本研究旨在比较接受含拉米夫定的HAART治疗的HBeAg阳性和HBeAg阴性合并感染患者的HBV动态变化。
我们回顾性分析了24例进入HAART治疗项目的HBsAg阳性HIV感染患者血浆HBV DNA水平的系列变化。使用了一种基于聚合酶链反应的检测方法，该方法能够定量低至400拷贝/ml的HBV。中位随访时间为18个月。
每天服用300mg拉米夫定的HAART有效地将血浆HBV-DNA抑制至基线水平的10^(-3)-10^(-5)倍，但观察到HBV DNA呈多相衰减。在研究的10例HBeAg阳性患者中的8例中，后期阶段变得平稳，成为持续的残余HBV病毒血症；相比之下，在研究的10例HBeAg阴性患者中未观察到残余HBV病毒血症（8/10 vs. 0/10，P=0.0007，Fisher精确检验）。不含拉米夫定的HAART未能抑制其余4例患者的血浆HBV DNA水平。
每天服用300mg拉米夫定的HAART可有效抑制HBeAg阴性HIV/HBV合并感染患者的HBV复制。然而，大多数HBeAg阳性合并感染患者中仍存在残余HBV复制。
