Su Mingze, Liao Lingjie, Xing Hui, Wang Shuai, Li Yutang, Lu Wei, He Lingyuan, Deng Juan, Shao Yiming, Li Tong, Zhuang Hui
Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China,
State Key Laboratory of Infectious Disease Prevention and Control, National Centre for AIDS/STD Control and Prevention, Chinese Centre for Disease Control and Prevention, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Beijing 102206, China.
Infect Drug Resist. 2018 Oct 2;11:1635-1644. doi: 10.2147/IDR.S173757. eCollection 2018.
This study aimed to investigate the HIV and hepatitis B virus (HBV) co-infection in three HIV high endemic areas with different modes of HIV transmission and explore the HBV nucleos(t)ide analogue resistance (NUCr) substitutions in this cohort receiving antiretroviral therapy (ART).
The enrolled 705 HIV-infected patients were from three different regions in China and received lamivudine-based ART for at least 1 year. After screening for hepatitis B surface antigen (HBsAg), the hepatitis B e antigen (HBeAg), and antibody against hepatitis B core antigen (anti-HBc and anti-HBc IgM), HBV DNA in plasma of patients positive for HBsAg was tested. The reverse transcriptase (RT) sequences of HBV were analyzed by direct sequencing.
The overall HBsAg-positive rate was 7.1% (50/705) (Guangxi [25/170, 14.7%], Xinjiang [13/257, 5.1%], and Henan [12/278, 4.3%]). The age, transmission route, and ethnic status were found to be associated with HIV/HBV co-infection. We obtained 23 HBV RT sequences belonging to genotypes B (9/23, 39.1%), C (13/23, 56.5%), and D (1/23, 4.4%). About 65.2% (15/23) of RT sequences harbored NUCr substitutions, all of which had combination substitution patterns. Patients with HBV NUCr had significantly higher HBV DNA level and ratio of HBeAg-positive than those without NUCr. None of the patients was found to have both lamivudine-resistant HBV and HIV.
Our results suggested that HBsAg-positive rate in the studied patients was similar to that of the general population in each of the studied regions, where the age, transmission route, and ethnic status might also play roles in HIV/HBV co-infection. The HBV combination NUCr substitutions were common in co-infected patients under ART. Monitoring of HBV infection and NUCr substitutions in HIV-infected patients would help in providing better clinical decisions and management, thus lowering patients' risks to develop end-stage liver diseases.
本研究旨在调查三个艾滋病病毒（HIV）高流行地区不同HIV传播模式下的HIV与乙型肝炎病毒（HBV）合并感染情况，并探索接受抗逆转录病毒治疗（ART）的该队列中HBV核苷（酸）类似物耐药（NUCr）替代情况。
纳入的705例HIV感染患者来自中国三个不同地区，接受以拉米夫定为主的ART治疗至少1年。在筛查乙型肝炎表面抗原（HBsAg）、乙型肝炎e抗原（HBeAg）以及乙型肝炎核心抗原抗体（抗-HBc和抗-HBc IgM）后，检测HBsAg阳性患者血浆中的HBV DNA。通过直接测序分析HBV的逆转录酶（RT）序列。
总体HBsAg阳性率为7.1%（50/705）（广西[25/170，14.7%]、新疆[13/257，5.1%]和河南[12/278，4.3%]）。发现年龄、传播途径和民族状况与HIV/HBV合并感染有关。我们获得了23条HBV RT序列，分别属于B基因型（9/23，39.1%）、C基因型（13/23，56.5%）和D基因型（1/23，4.4%）。约65.2%（15/23）的RT序列存在NUCr替代，均为联合替代模式。有HBV NUCr的患者HBV DNA水平和HBeAg阳性率显著高于无NUCr的患者。未发现患者同时感染对拉米夫定耐药的HBV和HIV。
我们的结果表明，研究患者中的HBsAg阳性率与各研究地区的一般人群相似，其中年龄、传播途径和民族状况可能也在HIV/HBV合并感染中起作用。HBV联合NUCr替代在接受ART的合并感染患者中很常见。监测HIV感染患者的HBV感染和NUCr替代情况将有助于做出更好的临床决策和管理，从而降低患者发生终末期肝病的风险。
