AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
Clin Infect Dis. 2013 Jun;56(12):1812-9. doi: 10.1093/cid/cit145. Epub 2013 Mar 13.
Hepatitis B virus (HBV) infection is common in individuals infected with human immunodeficiency virus, especially in men who have sex with men (MSM). Almost all currently used regimens of antiretroviral therapy (ART) contain lamivudine (LAM) or tenofovir disoproxil fumarate (TDF), both of which have significant anti-HBV activity. However, the prophylactic effect of ART on HBV infection has not been assessed previously.
Non-HBV-vaccinated HIV-infected MSM were serologically evaluated for HBV infection using stocked serum samples. Cases negative for HBV surface antigen (HBsAg), antibody to HBsAg (anti-HBs), and antibody to HBV core antigen (anti-HBc) in first serum samples were serologically followed until last available stocked samples. HBV genotype and LAM-resistant mutation (rtM204V/I) were analyzed in cases that became HBsAg-positive.
The first stocked samples were negative for all analyzed HBV serological markers in 354 of 1434 evaluated patients. The analysis of their last samples indicated HBV incident infection in 43 of them during the follow-up period. The rate of incident infections was lower during LAM- or TDF-containing ART (0.669 incident infections in 100 person-years) than during no ART period (6.726 incident infections in 100 person-years) and other ART (5.263 incident infections in 100 person-years) (P < .001). Genotype A was most prevalent (76.5%), and LAM-resistant HBV was more frequent in incident infections during LAM-containing ART (50.0%) than in those during no ART and other ART (7.1%) (P = .029).
LAM- and TDF-containing ART regimens seem to provide prophylaxis against HBV infection, although drug-resistant strains seem to evade these effects.
乙型肝炎病毒（HBV）感染在感染人类免疫缺陷病毒的个体中很常见，尤其是男男性行为者（MSM）。几乎所有目前使用的抗逆转录病毒治疗（ART）方案都包含拉米夫定（LAM）或富马酸替诺福韦二吡呋酯（TDF），这两种药物都具有显著的抗 HBV 活性。然而，ART 对 HBV 感染的预防作用以前尚未得到评估。
使用库存血清样本对未接种乙型肝炎疫苗的 HIV 感染的 MSM 进行 HBV 感染的血清学评估。在首次血清样本中 HBV 表面抗原（HBsAg）、HBsAg 抗体（抗-HBs）和 HBV 核心抗原抗体（抗-HBc）均为阴性的病例，进行血清学随访，直至获得最后一个库存样本。对出现 HBsAg 阳性的病例进行 HBV 基因型和 LAM 耐药突变（rtM204V/I）分析。
在 1434 例评估患者中，354 例首次库存样本的所有 HBV 血清学标志物均为阴性。对其最后样本的分析表明，在随访期间，其中 43 例发生了 HBV 新发感染。在包含 LAM 或 TDF 的 ART 期间（100 人年中有 0.669 例新发感染），新发感染的发生率低于无 ART 期间（100 人年中有 6.726 例新发感染）和其他 ART 期间（100 人年中有 5.263 例新发感染）（P<.001）。基因型 A 最为常见（76.5%），在包含 LAM 的 ART 中，与无 ART 和其他 ART 相比，LAM 耐药 HBV 在 LAM 耐药的新发感染中更为常见（50.0%比 7.1%）（P=0.029）。
包含 LAM 和 TDF 的 ART 方案似乎能提供 HBV 感染的预防作用，尽管耐药株似乎能逃避这些作用。
