Soriano Vincent, de Mendoza Carmen, Fernández-Montero José V, Labarga Pablo, Barreiro Pablo
Department of Infectious Diseases , Hospital Carlos III, Madrid , Spain.
Ann Med. 2014 Aug;46(5):290-6. doi: 10.3109/07853890.2014.899103. Epub 2014 Apr 10.
Chronic hepatitis B virus (HBV) infection is common in HIV-positive individuals, mainly among those with sexually risky behaviors. Although HBV vaccination is mandatory in all HIV-infected persons with negative HBV markers, lower rates of protection due to abnormal immune responses are achieved. HIV accelerates the course of liver disease caused by chronic HBV infection, leading rapidly to end-stage hepatic illness and increasing the risk of hepatocellular carcinoma. Treatment of HIV including nucleos(t)ide analogues active against HBV highly improves outcomes, especially when tenofovir is part of the antiviral regimen. The use of lamivudine as the only active anti-HBV agent in HIV-HBV co-infected patients should be limited to individuals with low serum HBV-DNA levels. Otherwise, selection of drug resistance may eliminate any clinical benefit, produce cross-resistance to other antivirals, and favor the emergence of HBV vaccine escape mutants.
慢性乙型肝炎病毒（HBV）感染在HIV阳性个体中很常见，主要发生在有性传播风险行为的人群中。尽管所有HBV标志物阴性的HIV感染者都必须接种HBV疫苗，但由于免疫反应异常，疫苗的保护率较低。HIV会加速慢性HBV感染所致肝病的进程，迅速导致终末期肝病，并增加肝细胞癌的风险。包括对HBV有效的核苷（酸）类似物在内的HIV治疗可显著改善治疗效果，尤其是当替诺福韦作为抗病毒方案的一部分时。在HIV-HBV合并感染患者中，将拉米夫定作为唯一有效的抗HBV药物使用应仅限于血清HBV-DNA水平较低的个体。否则，选择耐药性可能会消除任何临床益处，产生对其他抗病毒药物的交叉耐药性，并有利于HBV疫苗逃逸突变株的出现。
