Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.
Semin Liver Dis. 2012 May;32(2):114-9. doi: 10.1055/s-0032-1316466. Epub 2012 Jul 3.
Approximately 5 to 10% of human immunodeficiency virus- (HIV-) infected persons worldwide have chronic hepatitis B virus (HBV). The management of these patients merits special attention. They experience a faster progression to cirrhosis and more frequent liver-related death than HBV-monoinfected individuals. For this reason, therapy for both HIV and HBV is a priority in most cases. Some antivirals (i.e., tenofovir, lamivudine, emtricitabine) are active against both viruses and should be part of the antiretroviral treatment choice. However, drugs such as entecavir, telbivudine, or adefovir are active against HBV and may display some residual activity against HIV, occasionally leading to the selection of resistance mutations in the HIV polymerase, as is clearly shown with entecavir. Thus, they should be used only in the context of potent antiretroviral treatment. In this review, the authors will provide updated information on the natural history of HIV/HBV coinfected patients, when and which drugs should be used in treatment, and the concern about selection of drug resistance and vaccine escape mutants.
全球约有 5%至 10%的人类免疫缺陷病毒（HIV）感染者同时患有慢性乙型肝炎病毒（HBV）。这些患者的治疗需要特别关注。与单纯 HBV 感染者相比，他们更容易发展为肝硬化，肝脏相关死亡率更高。因此，在大多数情况下，同时治疗 HIV 和 HBV 是优先事项。一些抗病毒药物（如替诺福韦、拉米夫定、恩曲他滨）对两种病毒均有活性，应作为抗逆转录病毒治疗选择的一部分。然而，恩替卡韦、替比夫定或阿德福韦等药物仅对 HBV 有活性，对 HIV 可能有一定的残留活性，偶尔会导致 HIV 聚合酶中出现耐药突变，这一点在恩替卡韦中表现得很明显。因此，这些药物应仅在强效抗逆转录病毒治疗的背景下使用。在这篇综述中，作者将提供有关 HIV/HBV 合并感染患者自然史、何时以及应使用哪些药物进行治疗以及对耐药和疫苗逃逸突变体选择的关注的最新信息。
