Piroth Lionel, Sène Damien, Pol Stanislas, Goderel Isabelle, Lacombe Karine, Martha Benoit, Rey David, Loustau-Ratti Véronique, Bergmann Jean-François, Pialoux Gilles, Gervais Anne, Lascoux-Combe Caroline, Carrat Fabrice, Cacoub Patrice
Service de Maladies Infectieuses et Tropicales, CHU Dijon, 10 boulevard du Maréchal de Lattre de Tassigny, 21079 Dijon cedex, France.
AIDS. 2007 Jun 19;21(10):1323-31. doi: 10.1097/QAD.0b013e32810c8bcf.
To describe the characteristics of hepatitis B (HBV) infection in HIV-infected patients and the impact of anti-HBV treatments.
All the patients with past or present chronic HBV infection seen in October 2005 in 17 French hospitals were included. Data were retrospectively collected from their first visit in a time-dependent manner, through a detailed standardized questionnaire.
Among 477 HBV-infected patients, 261 (55%) were co-infected with HIV. The HBV-HIV co-infected patients underwent fewer serological, virological and histological evaluations. Initial positive HBe antigenemia (HBe Ag) was more frequent in these patients (57.9 versus 28.6%; P < 10), as was cirrhosis on the initial liver biopsy (17.9 versus 7.6%; P = 0.05). Throughout the mean 5-year follow-up, HBe Ag loss was less frequent (P = 0.04), as was HBe seroconversion (incidence rate 2.6 versus 10/100 patient-years; P < 10). HBe Ag loss was associated with fibrosis improvement (METAVIR score -0.5 +/- 0.4 versus +0.2 +/- 0.6 if persistent positive HBe Ag, P = 0.01). In co-infected patients on tenofovir, adefovir or interferon, HBe seroconversions were seen in patients on combined HBV treatment, the use of which is increasing (58% in 2005). Nevertheless, no significant difference in virological, immunological or biochemical evolution was observed between these different treatments.
In HBV-HIV co-infected patients, the assessment of HBV infection still needs to be improved, the HBV wild-type remains predominant, and HBe Ag loss is rare and associated with a better histological evolution. There is insufficient evidence of the superiority of combined HBV treatment, and this still needs be demonstrated in long term studies.
描述人类免疫缺陷病毒（HIV）感染患者的乙型肝炎病毒（HBV）感染特征以及抗HBV治疗的影响。
纳入2005年10月在17家法国医院就诊的所有既往或目前患有慢性HBV感染的患者。通过详细的标准化问卷，以时间依赖的方式回顾性收集他们首次就诊时的数据。
在477例HBV感染患者中，261例（55%）合并感染HIV。HBV-HIV合并感染患者接受的血清学、病毒学和组织学评估较少。这些患者中初始HBe抗原血症（HBe Ag）阳性更为常见（57.9%对28.6%；P<0.01），初始肝活检时肝硬化的比例也更高（17.9%对7.6%；P = 0.05）。在平均5年的随访期间，HBe Ag转阴较少见（P = 0.04），HBe血清学转换也较少见（发病率为2.6/100患者年对10/100患者年；P<0.01）。HBe Ag转阴与纤维化改善相关（METAVIR评分-0.5±0.4对持续HBe Ag阳性时的+0.2±0.6，P = 0.01）。在接受替诺福韦、阿德福韦或干扰素治疗的合并感染患者中，联合HBV治疗的患者出现了HBe血清学转换，联合治疗的使用正在增加（2005年为58%）。然而，在这些不同治疗之间，未观察到病毒学、免疫学或生化演变的显著差异。
在HBV-HIV合并感染患者中，HBV感染的评估仍需改进，HBV野生型仍然占主导，HBe Ag转阴罕见且与更好的组织学演变相关。联合HBV治疗优越性的证据不足，仍需长期研究来证实。
