Li Yijia, Xie Jing, Han Yang, Wang Huanling, Zhu Ting, Wang Nidan, Lv Wei, Guo Fuping, Qiu Zhifeng, Li Yanling, Du Shanshan, Song Xiaojing, Thio Chloe L, Li Taisheng
*Department of Infectious Diseases, Peking Union Medical College Hospital, Beijing, China; and †Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, MD.
J Acquir Immune Defic Syndr. 2016 May 1;72(1):39-45. doi: 10.1097/QAI.0000000000000927.
Although combination antiretroviral therapy (cART) including tenofovir (TDF)+lamivudine (3TC) or emtricitabine (FTC) is recommended for treatment of HIV/HBV coinfected patients, TDF is unavailable in some resource-limited areas. Some data suggest that 3TC monotherapy-based cART may be effective in patients with low pretreatment HBV DNA.
Prospective study of 151 Chinese HIV/HBV coinfected subjects of whom 60 received 3TC-based cART and 91 received TDF+3TC-based cART. Factors associated with HBV DNA suppression at 24 and 48 weeks, including anti-HBV drugs, baseline HBV DNA, and baseline CD4 cell count, were evaluated overall and stratified by baseline HBV DNA using Poisson regression with a robust error variance.
Baseline HBV DNA ≥20,000 IU/mL was present in 48.3% and 44.0% of subjects in the 3TC and TDF groups, respectively (P = 0.60). After 48 weeks of treatment, HBV DNA suppression rates were similar between these 2 groups (96.8% vs. 98.0% for 3TC and TDF+3TC, P > 0.999) in subjects with baseline HBV DNA <20,000 IU/mL; whereas in those with baseline HBV DNA ≥20,000 IU/mL, TDF+3TC was associated with higher suppression rates (34.5% vs. 72.5% in 3TC and TDF+3TC groups, respectively, P = 0.002). In stratified multivariate regression, TDF use (RR 1.98, P = 0.010) and baseline HBV DNA (per 1 log increase in International Units Per Milliliter, RR 0.74, P < 0.001) were associated with HBV DNA suppression only when baseline HBV DNA ≥20,000 IU/mL.
This study suggests that 3TC monotherapy-based cART is efficacious for HBV treatment through 48 weeks in HIV/HBV coinfection when baseline HBV DNA <20,000 IU/mL. Studies with long-term follow-up are warranted to determine if this finding persists.
尽管推荐使用包括替诺福韦（TDF）+拉米夫定（3TC）或恩曲他滨（FTC）的联合抗逆转录病毒疗法（cART）来治疗HIV/HBV合并感染患者，但在一些资源有限的地区无法获得TDF。一些数据表明，基于3TC单药治疗的cART可能对治疗前HBV DNA水平较低的患者有效。
对151名中国HIV/HBV合并感染受试者进行前瞻性研究，其中60名接受基于3TC的cART，91名接受基于TDF+3TC的cART。使用具有稳健误差方差的泊松回归，对24周和48周时与HBV DNA抑制相关的因素进行总体评估，并按基线HBV DNA进行分层，这些因素包括抗HBV药物、基线HBV DNA和基线CD4细胞计数。
3TC组和TDF组分别有48.3%和44.0%的受试者基线HBV DNA≥20,000 IU/mL（P =
0.60）。治疗48周后，基线HBV DNA<20,000 IU/mL的受试者中，这两组的HBV DNA抑制率相似（3TC组为96.8%，TDF+3TC组为98.0%，P>0.999）；而在基线HBV DNA≥20,000 IU/mL的受试者中，TDF+3TC的抑制率更高（3TC组和TDF+3TC组分别为34.5%和72.5%，P = 0.002）。在分层多变量回归中，仅当基线HBV DNA≥20,000 IU/mL时，使用TDF（RR 1.98，P = 0.010）和基线HBV DNA（每毫升国际单位增加1个对数，RR 0.74，P<0.001）与HBV DNA抑制相关。
本研究表明，当基线HBV DNA<
20,000 IU/mL时，基于3TC单药治疗的cART在HIV/HBV合并感染中对HBV治疗48周有效。需要进行长期随访研究以确定这一发现是否持续存在。
