Selabe S Gloria, Lukhwareni Azwidowi, Song Ernest, Leeuw Yeegan G M, Burnett Rosemary J, Mphahlele M Jeffrey
HIV and Hepatitis Research Unit, Department of Virology, University of Limpopo, Medunsa Campus, Pretoria, South Africa.
J Med Virol. 2007 Nov;79(11):1650-4. doi: 10.1002/jmv.20974.
This was an exploratory study to investigate lamivudine-resistant hepatitis B virus (HBV) strains in selected lamivudine-naïve HBV carriers with and without human immunodeficiency virus (HIV) co-infection in South African patients. Thirty-five lamivudine-naïve HBV infected patients with or without HIV co-infection were studied: 15 chronic HBV mono-infected patients and 20 HBV-HIV co-infected patients. The latter group was further sub-divided into 13 occult HBV (HBsAg-negative) and 7 overt HBV (HBsAg- positive) patients. HBsAg, anti-HBs, anti-HBc, and anti-HIV 1/2 were determined as part of routine diagnosis using Axsym assays (Abbott Laboratories, North Chicago, IL). Serum samples were PCR amplified with HBV reverse transcriptase (RT) primers, followed by direct sequencing across the tyrosine-methionine-aspartate-aspartate (YMDD) motif of the major catalytic region in the C domain of the HBV RT enzyme. HBV viral load was performed with Amplicor HBV Monitor test v2.0 (Roche Diagnostics, Penzberg, Germany). HBV lamivudine-resistant strains were detected in 3 of 15 mono-infected chronic hepatitis B patients and 10 of 20 HBV-HIV co-infected patients. To the best of our knowledge, this constitutes the first report of HBV lamivudine-resistant strains in therapy-naïve HBV-HIV co-infected patients. The HBV viral loads for mono-infected and co-infected patients ranged from 3.32 x 10(2) to 3.82 x 10(7) and <200 to 4.40 x 10(3) copies/ml, respectively. It remains to be seen whether such pre-existing antiviral mutations could result in widespread emergence of HBV resistant strains when lamivudine-containing highly active antiretroviral (ARV) treatment (HAART) regimens become widely applied in South Africa, as this is likely to have potential implications in the management of HBV-HIV co-infected patients.
这是一项探索性研究，旨在调查南非患者中初治的、合并或未合并人类免疫缺陷病毒（HIV）感染的乙肝病毒（HBV）携带者体内的拉米夫定耐药HBV毒株。研究了35例初治的HBV感染患者，其中有或无HIV合并感染：15例慢性HBV单感染患者和20例HBV-HIV合并感染患者。后一组又进一步分为13例隐匿性HBV（HBsAg阴性）患者和7例显性HBV（HBsAg阳性）患者。作为常规诊断的一部分，使用Axsym检测法（雅培实验室，美国伊利诺伊州北芝加哥）测定HBsAg、抗-HBs、抗-HBc和抗-HIV 1/2。血清样本用HBV逆转录酶（RT）引物进行PCR扩增，随后对HBV RT酶C结构域主要催化区域的酪氨酸-甲硫氨酸-天冬氨酸-天冬氨酸（YMDD）基序进行直接测序。用Amplicor HBV Monitor test v2.0（罗氏诊断公司，德国彭茨贝格）检测HBV病毒载量。在15例单感染慢性乙型肝炎患者中有3例、20例HBV-HIV合并感染患者中有10例检测到HBV拉米夫定耐药毒株。据我们所知，这是关于初治的HBV-HIV合并感染患者中HBV拉米夫定耐药毒株的首次报告。单感染和合并感染患者的HBV病毒载量分别为3.32×10²至3.82×10⁷拷贝/毫升和<200至4.40×10³拷贝/毫升。当含拉米夫定的高效抗逆转录病毒（ARV）治疗（HAART）方案在南非广泛应用时，这种预先存在的抗病毒突变是否会导致HBV耐药毒株的广泛出现还有待观察，因为这可能对HBV-HIV合并感染患者的管理产生潜在影响。
