Mallet Vincent O, Dhalluin-Venier Valérie, Verkarre Virginie, Correas Jean-Michel, Chaix Marie-Laure, Viard Jean-Paul, Pol Stanislas
Université Paris-Descartes, Paris, France.
Antivir Ther. 2007;12(2):279-83.
HIV infection worsens the course and the natural history of chronic hepatitis B (HBV) leading to rapid progression to cirrhosis and to end-stage liver disease. Highly active antiretroviral therapy (HAART) regimens including nucleoside and/or nucleotide analogues with activity against both HIV reverse transcriptase and hepatitis B virus polymerase have clearly improved the survival rates of HIV/HBV-coinfected patients. How HAART beneficially affects the natural course of chronic hepatitis B in coinfected patients is not known. We report a biopsy-proven case of reversal of HBV-related cirrhosis in a coinfected patient, paralleling long-term suppression of HBV replication with tenofovir disoproxil fumarate as part of a HAART. Pathological reversibility of cirrhosis was ascertained by normalization of biochemical (platelet count) and morphological (abdominal ultrasonography and gastrointestinal endoscopy) tests as well as non-invasive markers of fibrosis. In conclusion, a HAART regimen including tenofovir disoproxil fumarate in a HBV/HIV-coinfected cirrhotic patient might lead to sustained HBV viral suppression and result in cirrhosis reversal.
艾滋病毒感染会使慢性乙型肝炎（HBV）的病程和自然史恶化，导致迅速发展为肝硬化和终末期肝病。包括对艾滋病毒逆转录酶和乙型肝炎病毒聚合酶均有活性的核苷和/或核苷酸类似物的高效抗逆转录病毒疗法（HAART）方案，已显著提高了艾滋病毒/乙肝病毒合并感染患者的生存率。HAART如何对合并感染患者慢性乙型肝炎的自然病程产生有益影响尚不清楚。我们报告了1例经活检证实的合并感染患者的HBV相关肝硬化逆转病例，同时以替诺福韦酯作为HAART的一部分对HBV复制进行长期抑制。通过生化指标（血小板计数）和形态学指标（腹部超声检查和胃肠内镜检查）以及纤维化的非侵入性标志物的正常化，确定了肝硬化的病理可逆性。总之，在HBV/艾滋病毒合并感染的肝硬化患者中，包含替诺福韦酯的HAART方案可能会导致HBV病毒持续受到抑制，并使肝硬化逆转。
