Kim H Nina
Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA.
Center for AIDS Research, University of Washington, Seattle, WA.
Curr Hepatol Rep. 2020 Dec;19(4):345-353. doi: 10.1007/s11901-020-00541-x. Epub 2020 Sep 16.
The burden of chronic hepatitis B (HBV) remains disproportionately high among people living with HIV (PLWH) despite the advent of HBV vaccination and HBV-active antiretroviral therapy (ART). This review summarizes new insights and evolving issues in HIV-HBV coinfection.
HBV-HIV coinfection is still a leading cause of cirrhosis, hepatocellular carcinoma (HCC) and liver-related mortality more than a decade after the approval of tenofovir. While tenofovir-based ART has been shown to improve rates of HBV virologic suppression and halt fibrosis progression, the long-term benefits on the prevention of end-stage liver disease or HCC in HIV-HBV coinfection have yet to be convincingly demonstrated in PLWH. Missed opportunities for HBV vaccination persist despite evidence of ongoing risk for HBV infection in this population.
Even as we work towards HBV elimination and functional cure, ongoing efforts should focus on optimizing risk stratification as well as uptake of HBV-active antiviral therapy and HBV immunization in this priority population.
尽管有了乙肝疫苗和抗乙肝病毒活性抗逆转录病毒疗法（ART），但慢性乙型肝炎（HBV）在艾滋病毒感染者（PLWH）中的负担仍然过高。本综述总结了HIV-HBV合并感染的新见解和不断演变的问题。
在替诺福韦获批十多年后，HBV-HIV合并感染仍是肝硬化、肝细胞癌（HCC）和肝脏相关死亡率的主要原因。虽然基于替诺福韦的ART已被证明可提高HBV病毒学抑制率并阻止纤维化进展，但在PLWH中，其对预防HIV-HBV合并感染的终末期肝病或HCC的长期益处尚未得到令人信服的证明。尽管有证据表明该人群仍有感染HBV的风险，但乙肝疫苗接种的机会仍然被错过。
即使我们致力于消除HBV并实现功能性治愈，当前的努力仍应集中在优化风险分层，以及在这一重点人群中推广抗乙肝病毒活性抗病毒疗法和乙肝免疫接种。
