From the Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA.
Fred Hutchinson Cancer Research Center, Seattle, WA.
Pediatr Infect Dis J. 2021 Feb 1;40(2):e56-e61. doi: 10.1097/INF.0000000000002980.
There is limited information on perinatal outcomes in HIV-hepatitis B virus (HBV) coinfection.
HIV Prevention Trials Network (HPTN) 046 was a randomized double-blind placebo-controlled trial of perinatal transmission that evaluated 6 months of infant nevirapine versus placebo among breast-fed infants. Women living with HIV and their infants enrolled in sub-Saharan Africa from 2007 to 2010; 78% received antiretroviral therapy (ART). Maternal samples were tested for hepatitis B surface antigen (HBsAg). High and low HBV viral load (VL) was defined as ≥106 IU/mL and <106 IU/mL. The association between HIV-HBV coinfection and maternal and infant outcomes was assessed using multivariate (MV) logistic and Cox regression.
Among 2025 women, 88 (4.3%) had HBV. HIV-HBV women with high HBV VL had lower median CD4, versus HIV alone or HIV-HBV women with low HBV VL [320, 490 and 434 cells/mm3, respectively (P < 0.007)]. In MV analysis, adjusted for maternal CD4, age and maternal ART, infants born to women with high HBV VL were more likely to be low birth weight (LBW), versus HIV+/HBV- and low HBV VL women: [30% (3/10) vs. 10% (194/1953) vs. 6% (5/78), respectively, P = 0.03). High HBV VL was associated with HIV perinatal transmission [(hazard ratio 6.75 (95% confidence interval (CI): 1.86 - 24.50)]. There was no impact on infant mortality or maternal outcomes at 18 months.
In HIV-HBV women, high HBV viral loads increase the risk of LBW and potentially HIV perinatal transmission. Reduction of antepartum HBV viremia may have beneficial effects beyond the prevention of HBV perinatal transmission.
关于 HIV-乙型肝炎病毒（HBV）合并感染的围产期结局，相关信息有限。
HIV 预防试验网络（HPTN）046 是一项针对围产期传播的随机、双盲、安慰剂对照临床试验，评估了母乳喂养婴儿中使用奈韦拉平 6 个月与安慰剂的效果。2007 年至 2010 年间，在撒哈拉以南非洲招募了携带 HIV 的妇女及其婴儿；其中 78%接受了抗逆转录病毒治疗（ART）。检测了母亲样本的乙型肝炎表面抗原（HBsAg）。高和低 HBV 病毒载量（VL）定义为≥106 IU/mL 和<106 IU/mL。使用多变量（MV）逻辑和 Cox 回归评估 HIV-HBV 合并感染与母婴结局之间的关系。
在 2025 名女性中，88 名（4.3%）患有 HBV。与 HIV 单独感染或 HIV-HBV 且 HBV VL 较低的女性相比，HBV VL 较高的 HIV-HBV 女性的中位 CD4 水平更低[分别为 320、490 和 434 个细胞/mm3（P<0.007）]。在 MV 分析中，调整了母亲的 CD4、年龄和母亲的 ART，与 HIV+/HBV-和低 HBV VL 的女性相比，HBV VL 较高的女性所生婴儿更有可能为低出生体重（LBW）：[30%（3/10）vs. 10%（194/1953）vs. 6%（5/78），分别为，P=0.03]。高 HBV VL 与 HIV 围产期传播相关[风险比 6.75（95%置信区间（CI）：1.86-24.50）]。在 18 个月时，婴儿死亡率或母婴结局没有影响。
在 HIV-HBV 女性中，高 HBV 病毒载量增加了 LBW 和潜在的 HIV 围产期传播的风险。降低产前 HBV 病毒血症可能除了预防 HBV 围产期传播外还有有益的效果。
