Iser David M, Lewin Sharon R
Department of Medicine, Monash University, Victoria, Australia.
HIV Ther. 2009 Jul 1;3(4):405-415. doi: 10.2217/hiv.09.19.
Liver disease is a major cause of mortality in individuals with HIV-HBV coinfection. The pathogenesis of liver disease in this setting is unknown, but is likely to involve drug toxicity, infection of hepatic cells with both HIV and HBV, and an altered immune response to HBV. The availability of therapeutic agents that target both HIV and HBV replication enable dual viral suppression, and assessment of chronic hepatitis B is important prior to commencement of antiretroviral therapy. Greater importance is now placed on HBV DNA levels and staging of liver fibrosis, either by liver biopsy or noninvasive measurement, such as transient elastography, since significant liver fibrosis may exist in the presence of normal liver function tests. Earlier treatment of both HIV and HBV is now generally advocated and treatment is usually lifelong.
肝病是艾滋病毒与乙肝病毒合并感染患者死亡的主要原因。这种情况下肝病的发病机制尚不清楚，但可能涉及药物毒性、肝细胞同时感染艾滋病毒和乙肝病毒，以及对乙肝病毒的免疫反应改变。能够同时靶向艾滋病毒和乙肝病毒复制的治疗药物可实现双重病毒抑制，在开始抗逆转录病毒治疗之前评估慢性乙型肝炎很重要。现在更重视乙肝病毒DNA水平以及肝纤维化分期，可通过肝活检或非侵入性测量（如瞬时弹性成像）来进行，因为在肝功能检查正常的情况下可能存在显著肝纤维化。现在普遍提倡对艾滋病毒和乙肝病毒进行早期治疗，且治疗通常是终身的。
