Jain Mamta K, Vigil Karen J, Parisot Paul, Go Gabriella, Vu Trung, Li Xilong, Hansen Laura, Taylor Barbara S
UT Southwestern Medical Center, Department of Internal Medicine, Dallas, Texas, USA.
Parkland Health and Hospital System, Dallas, Texas, USA.
Open Forum Infect Dis. 2021 Apr 16;8(7):ofab116. doi: 10.1093/ofid/ofab116. eCollection 2021 Jul.
New therapies to achieve hepatitis B surface antigen (HBsAg) clearance are under development. However, gaps in knowledge exist in understanding the incidence and predictors of HBsAg clearance in a racially diverse HIV population.
We examined the incidence and risk of HBsAg clearance in a retrospective cohort of people with HIV/hepatitis B virus (HBV). Included patients had sufficient data to establish chronic infection based on Centers for Disease Control and Prevention guidelines. We examined the incident rate for HBsAg loss and hazard rate ratios to evaluate predictors for HBsAg clearance in a multivariable model.
Among 571 HIV/HBV patients, 87% were male, 61% were Black, 45% had AIDS, 48% were HBeAg positive, and the median follow-up was 88 months. Incident HBsAg clearance was 1.5 per 100 person-years. In the multivariate model, those with AIDS at baseline (adjusted hazard ratio [aHR], 2.43; 95% CI, 1.37-4.32), Hispanics (aHR, 3.57; 95% CI, 1.33-9.58), and those with injection drug use as an HIV risk factor (aHR, 3.35; 95% CI, 1.26-8.89) were more likely to lose HBsAg, whereas those who were HBeAg positive (aHR, 0.34; 95% CI, 0.19-0.63) were less likely to lose HBsAg. The median change in CD4 cell count during the observation period was 231 cells/mm in those with HBsAg loss vs 112 cells/mm in those with HBsAg persistence ( = .004).
HBsAg loss occurs in about 10% of those with chronic HBV infection. Being Hispanic, having AIDS at baseline, having an injection drug use history, and having HBeAg-negative status at baseline predicted the likelihood of HBsAg loss. Immune restoration may be a mechanism through which HBsAg loss occurs in HIV patients.
实现乙肝表面抗原（HBsAg）清除的新疗法正在研发中。然而，在了解种族多样化的HIV人群中HBsAg清除的发生率和预测因素方面，仍存在知识空白。
我们在一组HIV/乙肝病毒（HBV）感染者的回顾性队列中，研究了HBsAg清除的发生率和风险。纳入的患者有足够的数据，可根据疾病控制与预防中心的指南确定慢性感染情况。我们在多变量模型中，研究了HBsAg消失的发生率和风险比，以评估HBsAg清除的预测因素。
在571例HIV/HBV患者中，87%为男性，61%为黑人，45%患有艾滋病，48%HBeAg阳性，中位随访时间为88个月。HBsAg清除的发生率为每100人年1.5例。在多变量模型中，基线时患有艾滋病的患者（调整后风险比[aHR]，2.43；95%置信区间[CI]，1.37 - 4.32）、西班牙裔患者（aHR，3.57；95%CI，1.33 - 9.58）以及有注射吸毒作为HIV危险因素的患者（aHR，3.35；95%CI，1.26 - 8.89）更有可能失去HBsAg，而HBeAg阳性的患者（aHR，0.34；95%CI，0.19 - 0.63）失去HBsAg的可能性较小。在观察期内，HBsAg消失的患者CD4细胞计数的中位变化为231个细胞/mm³，而HBsAg持续存在的患者为112个细胞/mm³（P = 0.004）。
约10%的慢性HBV感染者会出现HBsAg消失。西班牙裔、基线时患有艾滋病、有注射吸毒史以及基线时HBeAg阴性状态可预测HBsAg消失的可能性。免疫恢复可能是HIV患者发生HBsAg消失的一种机制。
