Department of Infectious Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Center for AIDS Research, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
J Viral Hepat. 2022 Aug;29(8):616-626. doi: 10.1111/jvh.13704. Epub 2022 Jun 7.
Data on hepatitis B virus (HBV) pregenomic (pgRNA) levels in HIV/HBV coinfected patients pre- and post-combined antiretroviral therapy (cART) are limited. This study aimed to evaluate the distribution of HBV pgRNA levels in treatment-naive coinfected patients and explore the changes that occur after the initiation of cART by examining patients from multicentre cohort studies performed in China. We included HIV/HBV coinfected subjects from the China AIDS Clinical Trial cohorts established from 2008 to 2014. Clinical and serological markers of HIV and HBV infection and biochemical data were acquired at baseline and after 96 and 240-480 weeks of cART. The correlations between HBV pgRNA and HBV DNA levels as well as HBsAg levels were calculated using Spearman's bivariate correlation analysis, and multivariate regression analysis was performed to determine factors associated with undetectable HBV pgRNA levels before cART and HBeAg loss after cART. A total of 132 HIV/HBV coinfected patients were enrolled, and 100 individuals were HBeAg-negative. A total of 34.4% (32/93) of patients were positive for HBV pgRNA, and the median HBV pgRNA level was 4.92 (IQR: 4.21-6.12) log copies/mL before cART. The median HBV pgRNA level was significantly lower in HBeAg-negative individuals than in HBeAg-positive individuals (4.22 (IQR: 2.70-4.84) log copies/mL vs. 5.77 (IQR: 4.63-6.55) log copies/mL, p = 0.002). HBV pgRNA was moderately correlated with HBsAg (r = 0.594, p = 0.001), and positively associated with HBV DNA (r = 0.445, p = 0.011). The factors independently associated with undetectable HBV pgRNA level before cART were HBV DNA (OR: 5.61, 95% CI: 1.50-20.96, p = 0.01) and HBeAg status (OR: 5.95, 95% CI: 1.52-23.25, p = 0.01). A total of 87.5% (28/32) of patients were followed for a median duration of 138 (IQR: 54-240) weeks, and the HBV pgRNA levels became undetectable in seven patients. The 132 patients were observed for 695.5 person-years, and no HBsAg loss occurred. Thirteen individuals achieved HBeAg loss, four patients had undetectable levels of HBV pgRNA pre-cART, and the level of six individuals became undetectable during the 48-week (IQR: 48-264) follow-up period. HBeAg status was significantly associated with HBV pgRNA level in HIV/HBV coinfected patients pre- and post-cART. Additionally, undetectable HBV pgRNA level may be associated with HBeAg loss after cART.
在接受联合抗逆转录病毒治疗 (cART) 前后，关于 HIV/HBV 合并感染患者乙型肝炎病毒前基因组 (pgRNA) 水平的数据有限。本研究旨在评估未经治疗的合并感染患者的 HBV pgRNA 水平分布，并通过检查来自中国进行的多中心队列研究的患者，探讨 cART 后发生的变化。我们纳入了 2008 年至 2014 年期间在中国艾滋病临床研究队列中建立的 HIV/HBV 合并感染受试者。在基线时以及 cART 后 96 和 240-480 周时获得了 HIV 和 HBV 感染的临床和血清学标志物以及生化数据。使用 Spearman 双变量相关分析计算 HBV pgRNA 与 HBV DNA 水平和 HBsAg 水平之间的相关性，并进行多变量回归分析以确定 cART 前 HBV pgRNA 水平不可检测和 cART 后 HBeAg 丢失的相关因素。共纳入 132 例 HIV/HBV 合并感染患者，其中 100 例患者 HBeAg 阴性。共有 34.4%（32/93）的患者 HBV pgRNA 阳性，cART 前 HBV pgRNA 中位水平为 4.92（IQR：4.21-6.12）log 拷贝/ml。与 HBeAg 阳性患者相比，HBeAg 阴性患者的 HBV pgRNA 中位水平显著降低（4.22（IQR：2.70-4.84）log 拷贝/ml vs. 5.77（IQR：4.63-6.55）log 拷贝/ml，p=0.002）。HBV pgRNA 与 HBsAg 中度相关（r=0.594，p=0.001），与 HBV DNA 呈正相关（r=0.445，p=0.011）。与 cART 前 HBV pgRNA 水平不可检测相关的独立因素包括 HBV DNA（OR：5.61，95%CI：1.50-20.96，p=0.01）和 HBeAg 状态（OR：5.95，95%CI：1.52-23.25，p=0.01）。共有 87.5%（28/32）的患者中位随访 138（IQR：54-240）周，7 例患者的 HBV pgRNA 水平不可检测。132 例患者观察了 695.5 人年，未发生 HBsAg 丢失。13 人实现了 HBeAg 丢失，4 人在 cART 前 HBV pgRNA 水平不可检测，6 人的 HBV pgRNA 水平在 48 周（IQR：48-264）随访期间不可检测。在接受 cART 前后，HBV pgRNA 水平与 HIV/HBV 合并感染患者的 HBeAg 状态显著相关。此外，HBV pgRNA 水平不可检测可能与 cART 后 HBeAg 丢失有关。
