Lancaster General Health Family and Community Medicine Residency, Lancaster General Penn Medicine, Lancaster, Pennsylvania, USA.
AIDS. 2017 Sep 24;31(15):2115-2118. doi: 10.1097/QAD.0000000000001599.
: Hepatitis B virus (HBV) reactivation has been documented in association with multiple immunotherapy regimens . These reactivations can be life-threatening and result in fulminant hepatic failure. There are currently no reports of HBV reactivation on nivolumab treatment. This is a case of a patient with known HIV infection and previous HBV workup that revealed him to be anti-hepatitis B core antibody positive, hepatitis B surface antigen negative, and HBV DNA negative. He experienced a HBV reactivation while on therapy with nivolumab for stage IIIa poorly differentiated carcinoma of the lung, which was a recurrence from a prior surgically resected stage Ia well differentiated adenocarcinoma of the lung. He is a long-term nonprogressor in regards to his HIV and had previously had a negative HBV DNA level and had declined antiretroviral therapy until just prior to starting nivolumab. This case is also of interest as antiprogrammed death-1 receptors are involved in CD4-related HIV control , and the effects of nivolumab in a patient who was an HIV long-term nonprogressor are unknown. There was concern that he would develop increased HIV viremia and CD4-related immune dysfunction without antiretroviral therapy, and thus, he agreed to treatment prior to starting antineoplastic immunotherapy.
乙型肝炎病毒（HBV）再激活与多种免疫治疗方案有关。这些再激活可能危及生命，并导致暴发性肝衰竭。目前尚无关于纳武利尤单抗治疗导致 HBV 再激活的报告。这是一例已知 HIV 感染和既往 HBV 检查的患者，结果显示他乙肝核心抗体阳性，乙肝表面抗原阴性，HBV DNA 阴性。他在接受纳武利尤单抗治疗 IIIa 期低分化肺癌时发生了 HBV 再激活，这是先前手术切除的 I 期高分化肺腺癌的复发。他的 HIV 长期无进展，此前 HBV DNA 水平为阴性，并拒绝接受抗病毒治疗，直到开始纳武利尤单抗之前。该病例也很有趣，因为抗程序性死亡-1 受体参与 CD4 相关的 HIV 控制，而纳武利尤单抗在 HIV 长期无进展患者中的作用尚不清楚。人们担心他在没有抗病毒治疗的情况下会出现 HIV 病毒载量增加和 CD4 相关免疫功能障碍，因此，他在开始抗肿瘤免疫治疗前同意进行治疗。
