Infectious Disease Unit, Policlinico Tor Vergata of Rome, 00133 Rome, Italy.
Department of System Medicine, Tor Vergata University of Rome, 00133 Rome, Italy.
Viruses. 2024 Feb 23;16(3):348. doi: 10.3390/v16030348.
Hepatitis B Core antibody (HBcAb) positivity is the surrogate marker of hepatitis B occult infection. This condition is not a contraindication for switching to two-drug (2DR) antiretroviral therapy; however, the removal of tenofovir may contribute to poor control of HBV replication. A multicentre retrospective cohort study investigated the impact of HBcAb positivity on HIV control in patients switching to a 2DR with Lamivudine and Dolutegravir (3TC-DTG). In this study, a comparison analysis was conducted between HBcAb-positive and -negative PLWH regarding HIV-RNA suppression, considering: (1): Target Not Detected (TND) < 20 cp/mL; (2) Target Detected (TD) < 20 cp/mL; and (3) Detectable > 20 cp/mL and <50 cp/mL and >50 copies/mL. A total of 267 patients on 2DR with 3TC-DTG were included. In comparison to HBcAb-negative, HBcAb-positive patients were older (45 years [35-54]) and had a lower CD4+ nadir (248 vs. 349 cells/mmc, = 0.007). No difference in the maintenance of virological suppression was present in the two groups of patients before the switch. Although no patient had an HIV-RNA > 20 cp/mL after the switch, significantly fewer HBcAb-positive compared with -negative subjects resulted in TND at 12, 24, and 36 months after the switch: 52 (69.3%) versus 164 (85.4%), = 0.004, 50 [72.5%] versus 143 [89.9%], = 0.001, and 30 [66.7%] versus 90 [92.8%], = 0.001, respectively. HBcAb positivity is associated with an increased risk of suboptimal HIV suppression during the 36 months after 3TC/DTG simplification. This finding reinforces the relevance of the OBI condition in PLWH and raises the issue of careful virological monitoring of such cases.
乙型肝炎核心抗体（HBcAb）阳性是乙型肝炎隐匿性感染的替代标志物。这种情况不是切换到二药（2DR）抗逆转录病毒治疗的禁忌症；然而，替诺福韦的去除可能导致乙型肝炎病毒复制控制不佳。一项多中心回顾性队列研究调查了 HBcAb 阳性对切换到拉米夫定和度鲁特韦（3TC-DTG）的 2DR 的 HIV 控制的影响。在这项研究中，对 HBcAb 阳性和阴性 PLWH 进行了 HIV-RNA 抑制的比较分析，考虑了：（1）目标未检测到（TND）<20 cp/mL；（2）目标检测到（TD）<20 cp/mL；和（3）检测到>20 cp/mL 和<50 cp/mL 和>50 拷贝/mL。共纳入 267 例接受 2DR 治疗的 3TC-DTG 患者。与 HBcAb 阴性患者相比，HBcAb 阳性患者年龄较大（45 岁[35-54]），CD4+ 最低点较低（248 与 349 个细胞/mmc， = 0.007）。两组患者在切换前的病毒学抑制维持方面没有差异。尽管切换后没有患者的 HIV-RNA > 20 cp/mL，但与 HBcAb 阴性相比，HBcAb 阳性患者在切换后 12、24 和 36 个月时 TND 的比例明显较低：52（69.3%）与 164（85.4%）， = 0.004，50 [72.5%]与 143 [89.9%]， = 0.001，30 [66.7%]与 90 [92.8%]， = 0.001。HBcAb 阳性与切换后 3TC/DTG 简化后 36 个月期间 HIV 抑制不佳的风险增加相关。这一发现强调了隐匿性乙型肝炎感染在 PLWH 中的相关性，并提出了对这种情况进行仔细病毒学监测的问题。
