Tuma Paula, Pineda Juan Antonio, Labarga Pablo, Vidal Francesc, Rodriguez Carmen, Poveda Eva, Santos Jesús, Gonzalez-García Juan, Sobrino Paz, Tural Cristina, Soriano Vincent
Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.
Antivir Ther. 2011;16(4):585-9. doi: 10.3851/IMP1778.
The wide use of lamivudine (3TC) as oral therapy for chronic HBV infection has favoured the selection and circulation of 3TC-resistant HBV strains worldwide. Although transmission of 3TC-resistant HBV variants has been reported only sporadically, few studies have been conducted in the HIV population where exposure to 3TC has been greater forming part of antiretroviral therapy (ART) regimens.
All individuals positive for serum hepatitis B surface antigen (HBsAg), newly diagnosed with HIV-1 infection, naive to ART and enrolled in the Spanish HIV cohort (CoRIS) since 2004 were identified. The HBV polymerase gene was sequenced and drug resistance mutations were characterized retrospectively in stored frozen plasma specimens.
From 4,419 ART-naive HIV-1-infected individuals, 223 (5.1%) were positive for serum HBsAg. Baseline stored sera were available for 84 patients, of whom 73 could be characterized virologically. This population was mainly represented by men who had sex with men (52.1%), native Spaniards (65.7%) and Latin Americans (16.4%). The mean age was 36 years, mean CD4(+) T-cell count 375 cells/mm(3) and mean plasma HIV RNA 4.5 log(10) copies/ml. The HBV genotype distribution was 64% A, 20% F, 12% D and 4% others. Drug-resistant mutations in the HBV polymerase were found in four (5.5%) patients: two harboured rtL180M, one rtL80V and one rtV173L.
The rate of primary drug resistance in HBV among newly diagnosed HIV-HBV-coinfected patients in Spain is currently low (5.5%) and restricted to 3TC. Thus, HBV drug resistance testing before prescription of oral antiviral therapy is not warranted, although periodic surveillance might be recommended.
拉米夫定（3TC）作为慢性乙型肝炎病毒（HBV）感染的口服治疗药物被广泛使用，这促使3TC耐药HBV毒株在全球范围内被选择和传播。尽管3TC耐药HBV变异株的传播仅偶尔有报道，但在接受3TC治疗作为抗逆转录病毒治疗（ART）方案一部分的HIV人群中，相关研究较少。
确定自2004年以来所有血清乙型肝炎表面抗原（HBsAg）阳性、新诊断为HIV-1感染、未接受过ART且纳入西班牙HIV队列（CoRIS）的个体。对HBV聚合酶基因进行测序，并对储存的冷冻血浆标本进行回顾性耐药突变特征分析。
在4419例未接受过ART的HIV-1感染个体中，223例（5.1%）血清HBsAg阳性。84例患者有基线储存血清，其中73例可进行病毒学特征分析。该人群主要为男男性行为者（52.1%）、西班牙本地人（65.7%）和拉丁美洲人（16.4%）。平均年龄为36岁，平均CD4(+) T细胞计数为375个细胞/mm³，平均血浆HIV RNA为4.5 log(10)拷贝/ml。HBV基因型分布为：A型64%，F型20%，D型12%，其他型4%。在4例（5.5%）患者中发现了HBV聚合酶的耐药突变：2例携带rtL180M，1例携带rtL80V，1例携带rtV173L。
西班牙新诊断的HIV-HBV合并感染患者中，HBV的原发性耐药率目前较低（5.5%），且仅限于3TC。因此，在口服抗病毒治疗前进行HBV耐药检测并无必要，不过可建议进行定期监测。
