Campinas Reference Center for Sexually Transmitted Diseases/AIDS, Campinas, São Paulo State, Brazil.
J Venom Anim Toxins Incl Trop Dis. 2013 Dec 10;19(1):31. doi: 10.1186/1678-9199-19-31.
Hepatitis B virus (HBV) infects from 6 to 14% of HIV-infected individuals. Concurrent HIV/HBV infection occurs due to the overlapping routes of transmission, particularly sexual and parenteral. HIV-infected patients that have acute hepatitis B have six times greater risk of developing chronic hepatitis B, with higher viral replication, rapid progression to end-stage liver disease and shorter survival. The coinfection is also associated with poor response to hepatitis B treatment with interferon-alpha and increased liver toxicity to the antiretroviral therapy. Herein, we describe the case of a 35-year-old man who engages in sex with men and presented with newly diagnosed HIV-1, serological markers for acute hepatitis B and progression to chronic hepatitis B infection (HBsAg+ > 6 months, high alanine aminotransferase levels and moderate hepatitis as indicated by liver biopsy). Lacking indication of antiretroviral treatment (CD4 768 cells/mm3), he was treated with pegylated-interferon alpha2b (1.5 mg/kg/week) by subcutaneous injection for 48 weeks. Twelve weeks after treatment, the patient presented HBeAg seroconversion to anti-HBe. At the end of 48 weeks, he presented HBsAg seroconversion to anti-HBs. One year after treatment, the patient maintained sustained virological response (undetectable HBV-DNA). The initiation of antiretroviral therapy with nucleosides and nucleotides is recommended earlier for coinfected individuals. However, this report emphasizes that pegylated interferon remains an important therapeutic strategy to be considered for selected patients, in whom the initiation of HAART may be delayed.
乙型肝炎病毒 (HBV) 感染了 6%至 14%的 HIV 感染者。HIV/HBV 合并感染是由于重叠的传播途径，特别是性传播和血源性传播。急性乙型肝炎合并 HIV 感染的患者发生慢性乙型肝炎的风险增加六倍，病毒复制更高，快速进展为终末期肝病，生存期更短。这种合并感染还与干扰素-α治疗乙型肝炎的反应不佳以及抗逆转录病毒治疗的肝毒性增加有关。在此，我们描述了一位 35 岁的男性，他与男性发生性行为，新诊断出 HIV-1、急性乙型肝炎的血清学标志物和慢性乙型肝炎感染的进展（HBsAg+ > 6 个月，丙氨酸氨基转移酶水平高且中度肝炎，如肝活检所示）。由于没有抗逆转录病毒治疗的指征（CD4 768 个细胞/mm3），他接受了聚乙二醇干扰素 α2b（1.5mg/kg/周）皮下注射治疗 48 周。治疗 12 周后，患者 HBeAg 血清学转换为抗-HBe。治疗 48 周结束时，他 HBsAg 血清学转换为抗-HBs。治疗 1 年后，患者保持了持续的病毒学应答（HBV-DNA 不可检测）。建议合并感染的患者更早开始使用核苷（酸）类似物的抗逆转录病毒治疗。然而，本报告强调，聚乙二醇干扰素仍然是一种重要的治疗策略，可考虑用于某些患者，这些患者的 HAART 启动可能会延迟。
