乙型肝炎病毒和人类免疫缺陷病毒合并感染患者开始抗逆转录病毒治疗后乙肝表面抗原水平的动力学变化

The kinetics of the hepatitis B surface antigen level after the initiation of antiretroviral therapy for hepatitis B virus and human immunodeficiency virus coinfected patients.

作者信息

Mitsumoto Fujiko, Murata Masayuki, Ura Kazuya, Takayama Koji, Hiramine Satoshi, Shimizu Motohiro, Toyoda Kazuhiro, Ogawa Eiichi, Furusyo Norihiro, Hayashi Jun

机构信息

Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.

出版信息

J Infect Chemother. 2015 Apr;21(4):264-71. doi: 10.1016/j.jiac.2014.12.003. Epub 2014 Dec 18.

DOI:10.1016/j.jiac.2014.12.003

PMID:25596071

Abstract

BACKGROUND

Hepatic flares (HF), which reflect hepatitis B virus (HBV)-related immune reconstitution inflammatory syndrome (IRIS), frequently occur in patients with HBV and human immunodeficiency virus (HIV) coinfection after the start of antiretoroviral therapy (ART). The rate of hepatitis B envelope antigen (HBeAg) and hepatitis B surface antigen (HBsAg) loss is higher for patients with HF after the initiation of ART.

METHODS

We retrospectively examined the kinetics of the HBsAg and HBeAg levels of six HBV/HIV coinfected patients after the commencement of ART that included tenofovir. All were male and HBeAg positive.

RESULTS

Three patients developed HF after the initiation of ART. All subsequently lost HBeAg and one of them lost HBsAg after HF. None who did not experience HF lost HBeAg. The HBsAg and HBeAg levels remarkably decreased when HF occurred, but the decline of HBsAg was very slow in the periods before and after HF. The median decline of the HBsAg level at 48 weeks was 2.20 Log IU/mL for patients with HF, but only 1.00 Log IU/ml for patients without HF. Little decline was seen for either group in the median decline of the HBsAg level from 48 weeks to 96 weeks, 0.28 Log IU/mL in the HF group and 0.06 Log IU/mL in the non-HF group.

CONCLUSION

The immune reconstitution of a HBV/HIV coinfected patient plays an important role in the clearance of HBV. If HBsAg and HBeAg levels decrease rapidly when HF occurs, the hepatic flare would be due to HBV-related IRIS.

摘要

背景

肝 flare（HF）反映乙型肝炎病毒（HBV）相关免疫重建炎症综合征（IRIS），在接受抗逆转录病毒治疗（ART）的 HBV 和人类免疫缺陷病毒（HIV）合并感染患者中经常发生。ART 开始后，发生 HF 的患者乙肝 e 抗原（HBeAg）和乙肝表面抗原（HBsAg）丢失率更高。

方法

我们回顾性研究了 6 例接受包含替诺福韦的 ART 治疗的 HBV/HIV 合并感染患者的 HBsAg 和 HBeAg 水平变化情况。所有患者均为男性且 HBeAg 阳性。

结果

3 例患者在 ART 开始后发生 HF。所有发生 HF 的患者随后均丢失了 HBeAg，其中 1 例在发生 HF 后还丢失了 HBsAg。未发生 HF 的患者均未丢失 HBeAg。发生 HF 时，HBsAg 和 HBeAg 水平显著下降，但在 HF 发生前后 HBsAg 的下降非常缓慢。发生 HF 的患者在 48 周时 HBsAg 水平的中位数下降为 2.20 Log IU/mL，而未发生 HF 的患者仅为 1.00 Log IU/ml。从 48 周至 96 周，两组患者 HBsAg 水平中位数下降均不明显，HF 组为 0.28 Log IU/mL，非 HF 组为 0.06 Log IU/mL。