The Kirby Institute, University of New South Wales, Sydney, NSW 2010, Australia.
Clin Infect Dis. 2013 May;56(9):e87-94. doi: 10.1093/cid/cit002. Epub 2013 Jan 11.
Tenofovir (TDF) is effective for treatment of hepatitis B virus (HBV) in human immunodeficiency virus (HIV) infection; however, some individuals have ongoing HBV viremia, the reasons for which are unclear. We determined the patterns and factors associated with detectable HBV DNA in HIV-HBV-coinfected subjects on highly active antiretroviral therapy (HAART).
One hundred sixty-five HIV-HBV-coinfected individuals from the United States, Australia, and Thailand, the majority of whom were on HAART at study entry, were prospectively followed semiannually for a median of 2.8 years. Logistic regression was used to determine factors associated with detectable HBV DNA.
Anti-HBV regimens were TDF/emtricitabine (57%), lamivudine or emtricitabine (19%), or TDF monotherapy (13%). During follow-up, HBV DNA was detected at 21% of study visits and was independently associated with hepatitis B e antigen (HBeAg), HAART <2 years, CD4 <200 cells/mm(3), detectable HIV RNA, reporting <95% adherence, and anti-HBV regimen. TDF/emtricitabine was less likely to be associated with detectable HBV than other regimens, including TDF monotherapy (odds ratio, 2.79; P = .02). In subjects on optimal anti-HBV therapy (TDF/emtricitabine) and with undetectable HIV RNA, HBeAg, CD4 <200 mm(3), and reporting <95% adherence remained associated with detectable HBV DNA. Three main patterns of HBV viremia were observed: persistent HBV viremia, viral rebound (>1 log from nadir), and viral blips. No TDF resistance was identified.
Tenofovir/emtricitabine was superior to other anti-HBV regimens in long-term HBV suppression. HBV viremia on therapy was identified in 1 of 3 main patterns. Suboptimal adherence was associated with detectable HBV DNA during therapy, even when HIV was undetectable.
替诺福韦（TDF）对治疗人类免疫缺陷病毒（HIV）感染中的乙型肝炎病毒（HBV）有效；然而，一些个体仍存在 HBV 病毒血症，其原因尚不清楚。我们确定了在接受高效抗逆转录病毒治疗（HAART）的 HIV-HBV 合并感染患者中，与可检测到的 HBV DNA 相关的模式和因素。
来自美国、澳大利亚和泰国的 165 名 HIV-HBV 合并感染个体，其中大多数在研究入组时就已开始接受 HAART，前瞻性地每半年随访一次，中位随访时间为 2.8 年。使用逻辑回归确定与可检测到的 HBV DNA 相关的因素。
抗 HBV 方案为 TDF/恩曲他滨（57%）、拉米夫定或恩曲他滨（19%）或 TDF 单药治疗（13%）。在随访期间，21%的研究访视中检测到 HBV DNA，并且与乙型肝炎 e 抗原（HBeAg）、HAART<2 年、CD4<200 个细胞/mm(3)、可检测到的 HIV RNA、报告的<95%依从性以及抗 HBV 方案独立相关。TDF/恩曲他滨与其他方案（包括 TDF 单药治疗）相比，与可检测到的 HBV 的相关性较低（比值比，2.79；P=0.02）。在接受最佳抗 HBV 治疗（TDF/恩曲他滨）且 HIV RNA 不可检测的患者中，HBeAg、CD4<200 mm(3)和报告的<95%依从性与可检测到的 HBV DNA 仍相关。观察到 3 种主要的 HBV 病毒血症模式：持续性 HBV 病毒血症、病毒反弹（从最低点增加>1 对数）和病毒闪烁。未发现 TDF 耐药性。
TDF/恩曲他滨在长期 HBV 抑制方面优于其他抗 HBV 方案。在治疗期间，在 3 种主要模式中的 1 种中发现了 HBV 病毒血症。即使 HIV 不可检测，治疗期间不依从也与可检测到的 HBV DNA 相关。
