The Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital.
Department of Infectious Diseases, The Alfred Hospital and Monash University.
Curr Opin HIV AIDS. 2020 May;15(3):193-199. doi: 10.1097/COH.0000000000000624.
To examine issues specific to HIV--HBV co-infection that are relevant to the search for and achieving hepatitis B cure in this the setting RECENT FINDINGS: In HIV--HBV co-infection, high rates of hepatitis B surface antigen (HBsAg) loss early after initiation of HBV-active antiretroviral therapy (ART) have previously been reported. Between 2012 and 2016, HBsAg loss from 2.8 to 23% was reported in numerous studies, including those already on suppressive HBV-active ART. Data published in 2018-2019 show that these rates have remained fairly stable (3.0-13.9%). However, it appears that higher HBsAg loss on starting HBV-active ART in co-infection falls within a few years to levels similar to that observed in long-term treated HBV mono-infection. Immune reconstitution and CD4+ T-cell recovery are likely to play a role in high HBsAg loss rates seen in early treated co-infection, although the mechanisms driving this are yet to be fully elucidated.
High rates of HBsAg loss early after HBV-active ART initiation is unique to HIV--HBV co-infection, making it the ideal setting to investigate underlying mechanisms of HBV loss and develop new HBV cure strategies. This phenomenon could be used to enhance HBsAg loss with new therapeutic approaches currently being investigated; however, this is obstructed by excluding co-infection from such studies.
探讨 HIV-HBV 合并感染相关的特殊问题，这些问题与在这种情况下寻找和实现乙型肝炎治愈有关。
在 HIV-HBV 合并感染中，先前已有报道称，在开始 HBV 活性抗逆转录病毒治疗（ART）后早期，乙型肝炎表面抗原（HBsAg）的清除率很高。在 2012 年至 2016 年期间，许多研究报告了 HBsAg 从 2.8%到 23%的清除率，包括已经接受抑制性 HBV 活性 ART 的研究。2018-2019 年发表的数据表明，这些比率一直相当稳定（3.0%-13.9%）。然而，在合并感染中，开始 HBV 活性 ART 时较高的 HBsAg 清除率似乎在几年内下降到与长期治疗的 HBV 单感染相似的水平。免疫重建和 CD4+T 细胞恢复可能在早期治疗的合并感染中高 HBsAg 清除率中发挥作用，尽管驱动这种作用的机制尚未完全阐明。
HBV 活性 ART 开始后早期 HBsAg 清除率高是 HIV-HBV 合并感染所特有的，使其成为研究 HBV 清除的潜在机制和开发新的乙型肝炎治愈策略的理想环境。这种现象可以用于增强新治疗方法的 HBsAg 清除率，这些新的治疗方法目前正在研究中；然而，由于将合并感染排除在这些研究之外，这受到了阻碍。
