Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.
AIDS. 2011 Jan 2;25(1):73-9. doi: 10.1097/QAD.0b013e328340fde2.
Chronic hepatitis B virus (HBV) infection is common in HIV-positive individuals and increases liver-related mortality. Nucleos(t)ide analogues with activity against both HBV and HIV are widely used in coinfected patients, but its long-term effect on liver disease is unknown.
Clinical outcomes, HBsAg and/or HBeAg clearance, and changes in liver stiffness were longitudinally evaluated retrospectively in all HIV-HBV-coinfected individuals followed at our institution.
A total of 92 patients with HIV-HBV coinfection were identified, 19 of them superinfected with hepatitis delta virus. Their median time of follow-up was 35 months. Overall, 94% received lamivudine/emtricitabine and 82% tenofovir. Serum HBV-DNA was undetectable in 89%. Seven patients cleared serum HBsAg (2.6/100 patient-years), in four of them accompanied with anti-HBs seroconversion. Of note, two of them had hepatitis delta. Another 11 out of 42 HBeAg-positive patients cleared HBeAg (9/100 patient-years) and five of them experienced anti-HBe seroconversion. Liver decompensation and death occurred in eight (2.9/100 patient-years) and six (2.2/100 patient-years), respectively.At baseline, liver fibrosis was defined as null-mild (48%), moderate-advanced (28%) or cirrhosis (24%). At last visit, after a median of 40 months in 71 patients, 75% showed no changes, whereas improvement was recognized in 17% and worsening in 8%.
Most HIV-HBV-coinfected patients treated with anti-HBV active nucleos(t)ide analogues experience an amelioration of liver fibrosis progression, with low rates of hepatic decompensation and death. Serum HBeAg or HBsAg seroconversion occurs at yearly rates of 9 and 2.6%, respectively, even in patients with delta hepatitis.
慢性乙型肝炎病毒（HBV）感染在 HIV 阳性个体中很常见，并且会增加与肝脏相关的死亡率。具有抗 HBV 和 HIV 活性的核苷（酸）类似物广泛用于合并感染患者，但长期对肝脏疾病的影响尚不清楚。
对在本机构接受治疗的所有 HIV-HBV 合并感染患者进行了回顾性纵向评估，以评估临床结局、HBsAg 和/或 HBeAg 清除率以及肝硬度的变化。
共确定了 92 例 HIV-HBV 合并感染患者，其中 19 例合并感染了乙型肝炎 delta 病毒。他们的中位随访时间为 35 个月。总体而言，94%的患者接受了拉米夫定/恩曲他滨和 82%的患者接受了替诺福韦。89%的患者血清 HBV-DNA 不可检测。7 例患者（2.6/100 患者年）清除了血清 HBsAg，其中 4 例伴有抗-HBs 血清转换。值得注意的是，其中 2 例有乙型肝炎 delta 病毒感染。42 例 HBeAg 阳性患者中，又有 11 例（9/100 患者年）清除了 HBeAg，其中 5 例发生了抗-HBe 血清转换。8 例（2.9/100 患者年）和 6 例（2.2/100 患者年）分别发生了肝功能失代偿和死亡。基线时，肝纤维化定义为无明显/轻度（48%）、中度-重度（28%）或肝硬化（24%）。在中位随访 40 个月后，71 例患者中有 75%无变化，17%有改善，8%有恶化。
大多数接受抗 HBV 活性核苷（酸）类似物治疗的 HIV-HBV 合并感染患者的肝纤维化进展得到改善，肝功能失代偿和死亡的发生率较低。血清 HBeAg 或 HBsAg 血清转换的年发生率分别为 9%和 2.6%，即使在合并乙型肝炎 delta 病毒感染的患者中也是如此。
