Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
Liver Int. 2019 Aug;39(8):1408-1417. doi: 10.1111/liv.14059. Epub 2019 Feb 17.
Tenofovir disoproxil fumarate (TDF) is active against both HBV and HIV. Whether the introduction of TDF-containing combination antiretroviral therapy (cART) has improved the outcome of HIV/HBV-coinfected patients remains unclear in areas of higher HBV endemicity.
We retrospectively reviewed medical records of newly diagnosed antiretroviral-naïve HIV-infected patients between 2007 and 2015. Four groups of patients were defined, according to the HBV status and availability of TDF for HIV treatment in Taiwan in 2011. The primary outcome was all-cause mortality.
During the 9-year study period, 1,723 HIV-infected patients were included, with a median age of 31 years and baseline CD4 count of 273 cells per μL. The HBV seroprevalence had declined from 18.1% (125/692) in the pre-TDF era to 10.1% (104/1031) in the post-TDF era. The respective mortality rate for HIV/HBV-coinfected and HIV-monoinfected patients in the pre-TDF era was 23.2 (95% CI, 12.5-43.1) and 9.6 (95% CI, 6.1-15.0) deaths per 1000 person-years of follow-up [PYFU], and the respective mortality rate in the post-TDF era was 15.7 (95% CI, 7.0-34.8) and 8.0 (95% CI, 5.5-11.6) deaths per 1000 PYFU. The adjusted hazard ratio for mortality in multivariate Cox proportional-hazards regression analysis among HIV/HBV-coinfected patients compared to HIV-monoinfected patients was 2.79 (95% CI, 1.25-6.22) in pre-TDF era and 1.11 (95% CI, 0.45-2.72) in post-TDF era.
In this country of high HBV endemicity, the adverse impact of chronic HBV infection on the survival observed in the pre-TDF era has significantly diminished among HIV/HBV-coinfected patients compared to HIV-monoinfected patients in the era of TDF-containing cART.
富马酸替诺福韦二吡呋酯（TDF）对乙型肝炎病毒（HBV）和人类免疫缺陷病毒（HIV）均有活性。在乙型肝炎病毒（HBV）高发地区，TDF 联合抗逆转录病毒治疗（cART）的引入是否改善了 HIV/HBV 合并感染患者的结局尚不清楚。
我们回顾性分析了 2007 年至 2015 年间新诊断的抗逆转录病毒初治 HIV 感染患者的病历。根据 2011 年台湾 TDF 用于 HIV 治疗的情况和患者的 HBV 状态，将患者分为四组。主要结局为全因死亡率。
在 9 年的研究期间，共纳入 1723 例 HIV 感染患者，中位年龄为 31 岁，基线时 CD4 计数为 273 个细胞/μL。HBV 血清流行率从 TDF 时代前的 18.1%（125/692）降至 TDF 时代后的 10.1%（104/1031）。在 TDF 时代前，HIV/HBV 合并感染和 HIV 单感染患者的死亡率分别为每 1000 人年随访（PYFU）23.2（95%CI，12.5-43.1）和 9.6（95%CI，6.1-15.0）死亡，而在 TDF 时代后，死亡率分别为每 1000 PYFU 15.7（95%CI，7.0-34.8）和 8.0（95%CI，5.5-11.6）死亡。多变量 Cox 比例风险回归分析显示，与 HIV 单感染患者相比，HIV/HBV 合并感染患者的死亡调整风险比（HR）在 TDF 时代前为 2.79（95%CI，1.25-6.22），在 TDF 时代后为 1.11（95%CI，0.45-2.72）。
在乙型肝炎病毒（HBV）高发的国家，与 TDF 联合 cART 时代的 HIV 单感染患者相比，HIV/HBV 合并感染患者慢性 HBV 感染对生存的不良影响在 TDF 时代明显降低。
