免疫重建诱导的肝 flares 对乙型肝炎病毒/人类免疫缺陷病毒-1 合并感染患者乙型肝炎表面抗原丢失的影响。
Impact of Immune Reconstitution-Induced Hepatic Flare on Hepatitis B Surface Antigen Loss in Hepatitis B Virus/Human Immunodeficiency Virus-1 Coinfected Patients.
机构信息
Department of Liver Disease, Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa, Japan.
Genome Medical Sciences Project, National Center for Global Health and Medicine, Ichikawa, Japan.
出版信息
J Infect Dis. 2021 Jun 15;223(12):2080-2089. doi: 10.1093/infdis/jiaa662.
BACKGROUND
Hepatitis B surface antigen (HBsAg) loss is an ideal goal for chronic hepatitis B patients. Antiretroviral therapy (ART) in hepatitis B virus/human immunodeficiency virus-1 (HBV/HIV-1)-coinfected patients can lead to hepatic flare (HF) caused by immune reconstitution-induced inflammatory syndrome (IRIS). Here, we investigated the impact of IRIS-HF on HBsAg loss.
METHODS
This was a retrospective study of 58 HBV/HIV-1-coinfected subjects HBsAg-positive for ≥6 months before ART initiation and followed for ≥1 year (median 9.9 years) after ART initiation. We examined humoral factors in sera from healthy volunteers, HIV-monoinfected patients, and HBV/HIV-1-coinfected patients with IRIS-HF or acute hepatitis B infection.
RESULTS
During ART, HBsAg loss was observed in 20 of 58 HBV/HIV-1-coinfected patients (34.5%). Of the 58 patients, 15 (25.9%) developed IRIS-HF within 12 months of ART initiation. HBsAg loss was more frequent among patients who developed IRIS-HF (11/15, 73.3%) than those who did not (9/43, 20.9%). Multivariate analysis showed IRIS-HF was an independent predictor of subsequent HBsAg loss. Younger age and higher baseline HBV DNA titer were associated with IRIS-HF. Elevation of sCD163, not CXCL9, CXC10, CXCXL11, or CXCL13, was observed at IRIS-HF.
CONCLUSIONS
IRIS-HF was associated with HBsAg loss in HBV/HIV-1-coinfected patients.
背景
乙肝表面抗原（HBsAg）的清除是慢性乙型肝炎患者的理想目标。乙型肝炎病毒/人类免疫缺陷病毒 1（HBV/HIV-1）合并感染患者的抗逆转录病毒治疗（ART）可导致免疫重建炎症综合征（IRIS）引起的肝衰竭（HF）。在这里，我们研究了 IRIS-HF 对 HBsAg 清除的影响。
方法
这是一项回顾性研究，纳入了 58 名在开始 ART 前 HBsAg 阳性时间≥6 个月且在开始 ART 后随访时间≥1 年（中位数为 9.9 年）的 HBV/HIV-1 合并感染患者。我们检测了健康志愿者、HIV 单感染患者和发生 IRIS-HF 或急性乙型肝炎感染的 HBV/HIV-1 合并感染患者血清中的体液因素。
结果
在 ART 期间，58 名 HBV/HIV-1 合并感染患者中有 20 名（34.5%）观察到 HBsAg 清除。在 58 名患者中，有 15 名（25.9%）在开始 ART 后 12 个月内发生 IRIS-HF。发生 IRIS-HF 的患者（11/15，73.3%）比未发生 IRIS-HF 的患者（9/43，20.9%）HBsAg 清除更为频繁。多变量分析显示，IRIS-HF 是随后 HBsAg 清除的独立预测因素。年龄较小和较高的基线 HBV DNA 载量与 IRIS-HF 相关。在 IRIS-HF 时观察到 sCD163 升高，而非 CXCL9、CXC10、CXCXL11 或 CXCL13。
结论
IRIS-HF 与 HBV/HIV-1 合并感染患者的 HBsAg 清除相关。
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