Centre for Clinical Infection, The James Cook University Hospital, Marton Road, Middlesbrough, UK.
J Antimicrob Chemother. 2012 Dec;67(12):2939-42. doi: 10.1093/jac/dks333. Epub 2012 Aug 21.
HIV/hepatitis B virus (HBV) coinfection is common in Ghana, where first-line antiretroviral therapy (ART) comprises lamivudine with zidovudine or stavudine and nevirapine or efavirenz. Little is known about ART outcomes in the context of coinfection. This study evaluated outcomes of ART among HIV/HBV-coinfected Ghanaians, focusing on locally available parameters.
An observational study comparing clinical and virological outcomes in HIV-infected individuals who were either hepatitis B surface antigen (HBsAg) positive or HBsAg negative was conducted over 36 months. Clinical events, hepatic transaminases, CD4 count and body mass index (BMI) were evaluated among 143 HBsAg-positive and 228 HBsAg-negative patients. In a random subset of HBsAg-positive patients, HBV-DNA levels and polymerase sequences were analysed.
Comparing HBsAg-positive and HBsAg-negative patients, 44/143 (30.8%) and 83/228 (36.4%) defaulted follow-up, 15/143 (10.5%) and 30/228 (13.2%) experienced a new clinical event, and 8/143 (5.6%) and 11/228 (4.8%) discontinued their initial regimen, respectively. Transaminase levels were higher in HBsAg-positive patients, although elevations were low grade. HBV coinfection was associated with an adjusted 2.04 (95% CI 0.59-3.49) cells/mm(3)/month smaller CD4 cell increase; there was no significant effect on BMI changes. After a median of 9 months of ART, 64/66 (97.0%) patients showed detectable HBV-DNA (median 3.3 log(10) IU/mL; IQR 2.6-6.2); 12/53 (22.6%) of these showed lamivudine-associated resistance mutations.
HIV/HBV-coinfected Ghanaians tolerated first-line ART well, but experienced blunted CD4 cell responses. There was evidence of ongoing HBV replication, mild but persistent transaminase elevations and emerging lamivudine resistance in a proportion of treated patients, indicating the potential for progressive liver damage.
在加纳，一线抗逆转录病毒疗法（ART）包括拉米夫定联合齐多夫定或司他夫定、奈韦拉平或依非韦伦，HIV/乙型肝炎病毒（HBV）合并感染较为常见。对于合并感染患者的 ART 结局，人们知之甚少。本研究评估了加纳 HIV/HBV 合并感染患者的 ART 结局，并重点关注了当地可获得的参数。
本观察性研究在 36 个月的时间内，比较了 HBV 表面抗原（HBsAg）阳性或 HBsAg 阴性的 HIV 感染者的临床和病毒学结局。对 143 例 HBsAg 阳性和 228 例 HBsAg 阴性患者进行了临床事件、肝转氨酶、CD4 计数和体重指数（BMI）评估。在 HBsAg 阳性患者的随机亚组中，分析了 HBV-DNA 水平和聚合酶序列。
与 HBsAg 阳性患者相比，44/143（30.8%）和 83/228（36.4%）患者失访，15/143（10.5%）和 30/228（13.2%）患者出现新的临床事件，8/143（5.6%）和 11/228（4.8%）患者分别停用初始治疗方案。尽管 HBsAg 阳性患者的转氨酶水平升高，但升高程度较轻。HBV 合并感染与调整后的 CD4 细胞增加量减少 2.04（95%CI 0.59-3.49）个/mm3相关；对 BMI 变化无显著影响。ART 中位时间为 9 个月后，66/66（97.0%）患者可检测到 HBV-DNA（中位数为 3.3 log10 IU/mL；IQR 2.6-6.2）；其中 12/53（22.6%）患者显示出拉米夫定相关耐药突变。
加纳 HIV/HBV 合并感染患者对一线 ART 耐受良好，但 CD4 细胞反应减弱。部分治疗患者存在持续的 HBV 复制、轻度但持续的转氨酶升高和新兴的拉米夫定耐药，表明存在进行性肝损伤的潜在风险。
