Department of Infectious Diseases & Tropical Medicine, North Manchester General, Hospital, Manchester, UK.
AIDS. 2011 May 15;25(8):1051-6. doi: 10.1097/QAD.0b013e328345ef5e.
Combination emtricitabine (FTC) or lamivudine (LAM) with tenofovir disoproxil (TDF) is the recommended first-line regime for treatment in chronic hepatitis B virus (HBV)/HIV co-infection. However, in those failing to suppress, few data exist regarding further management. In HBV/HIV co-infection, there are no published data describing outcomes when entecavir (ETV) is then added to TDF-based regimes in patients no longer suppressing their HBV. We report the first series of patients using ETV with truvada-based HAART in HBV/HIV co-infected patients with previous HBV therapy failure, including inadequate suppression.
A prospective observational study.
Thirteen HIV/HBV co-infected patients (all male, hepatitis B e antigen positive and hepatitis B e antibody negative) were commenced on ETV in addition to background truvada. All patients were previously exposed to LAM or FTC and TDF (median 53 months, range 6−123). Seven patients had LAM monotherapy prior to TDF/LAM or FTC combination; the remaining six patients were exposed to FTC or LAM and TDF combination. Median time of follow-up was 74 weeks (range 16−159) and median HBV decline was 2.53 log(10) IU/ml (range 1.28−7.36). Thirty-eight percent of patients achieved undetectable HBV DNA level by the end of the study and eight of 13 (62%) achieved normal alanine aminotransferase (ALT) levels with median reduction −28 U/l (range −152 to 37). TDF was stopped in one patient because of renal toxicity. ETV was well tolerated with no change of estimated glomerular filtration rate during the study.
Entecavir can be considered in addition to TDF/FTC in HBV/HIV co-infected treatment-experienced patients failing to fully suppress their HBV viral load.
在慢性乙型肝炎病毒（HBV）/HIV 合并感染的治疗中，推荐使用恩曲他滨（FTC）或拉米夫定（LAM）联合替诺福韦二吡呋酯（TDF）作为一线治疗方案。然而，对于那些未能抑制病毒复制的患者，关于进一步治疗的资料很少。在 HBV/HIV 合并感染中，尚无资料描述在 HBV 病毒载量未能充分抑制的情况下，加用替诺福韦酯（TDF）治疗方案的患者改用恩曲他滨（ETV）的结果。我们报告了第一组使用 ETV 联合替诺福韦富马酸替诺福韦二吡呋酯（TDF/FTC）治疗方案的患者，这些患者既往曾接受过 HBV 治疗，包括治疗失败。
前瞻性观察性研究。
13 例 HIV/HBV 合并感染患者（均为男性，乙肝 e 抗原阳性，乙肝 e 抗体阴性）在背景替诺福韦富马酸替诺福韦二吡呋酯（TDF/FTC）的基础上加用 ETV。所有患者既往均接受过拉米夫定或 FTC 与 TDF（中位数 53 个月，范围 6−123）联合治疗。7 例患者在 TDF/LAM 或 FTC 联合治疗前曾接受 LAM 单药治疗；其余 6 例患者曾接受 FTC 或 LAM 与 TDF 联合治疗。中位随访时间为 74 周（范围 16−159），HBV 下降中位数为 2.53 log10 IU/ml（范围 1.28−7.36）。研究结束时，38%的患者达到了 HBV DNA 不可检测水平，13 例患者中有 8 例（62%）达到了正常丙氨酸氨基转移酶（ALT）水平，中位数降低了−28 U/l（范围−152 至 37）。因肾毒性，1 例患者停用了替诺福韦。在研究期间，ETV 耐受性良好，估计肾小球滤过率无变化。
对于 HBV/HIV 合并感染、有治疗史、未能完全抑制 HBV 病毒载量的患者，可以考虑在 TDF/FTC 的基础上加用恩曲他滨。
