Bertoni Costanza, Diotallevi Sara, Lolatto Riccardo, Piromalli Girolamo, Hasson Hamid, Siribelli Alessia, Bagaglio Sabrina, Foppa Caterina Uberti, Castagna Antonella, Morsica Giulia
Unit of Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.
Department of Infectious Diseases, Vita-Salute University San Raffaele, Milan, Italy.
J Med Virol. 2025 Sep;97(9):e70573. doi: 10.1002/jmv.70573.
We investigated factors associated with HBV-rebound in people with HIV (PWH) with chronic HBV (CHBV) under HBV-active antiretroviral therapy (ART): emtricitabine (FTC)+tenofovir alafenamide (TAF) or 3TC/FTC+ tenofovir disoproxil fumarate (TDF) regimen. The present study included PWH/CHBV followed as outpatients from October 2008 to August 2023 at San Raffaele Hospital, Milan, Italy. The baseline evaluation was the date of first negative HBV-DNA (< 10 IU/mL) after the first positive result before HBV active ART. Last evaluation (LE) was the first HBV-rebound (≥ 10 IU/mL) or last HBV undetectable in persistently HBV-DNA negative PWH. Odds ratio (and corresponding 95% confidence interval) of HBV-rebound, adjusted for nadir CD4 cells, ALT levels, and ART active on both viruses was estimated by multivariable logistic regression. Of 153 PWH/CHBV under ART active on both viruses, 25 (16.3%) had at least one HBV-rebound. Multivariate analysis at LE, showed that PWH on 3TC/FTC had a higher probability of HBV-rebound [adjusted odds ratio, aOR=4.88 (95%confidence interval, CI = 1.28, 20.10), p = 0.02], while PWH on FTC + TAF had lower probability of HBV-rebound [aOR = 0.05 (95%CI = 0.002, 0.27), p = 0.005], both compared to those on 3TC/FCT + TDF. Hepatitis B-rebound was associated with higher ALT levels [aOR=1.03 (95% CI = 1.01, 1.05) per 1-U/L higher, p = 0.001]. FTC + TAF based ART seemed to be related to a better control of HBV-DNA than 3TC/FTC + TDF and 3TC/FTC alone. Hepatitis B-rebound may exert an effect on liver inflammation, as suggested by the increase of transaminases levels.
我们调查了在接受乙肝激活抗逆转录病毒疗法（ART）的慢性乙肝（CHBV）合并人类免疫缺陷病毒（HIV）感染者（PWH）中，与乙肝病毒反弹相关的因素：恩曲他滨（FTC）+替诺福韦艾拉酚胺（TAF）或拉米夫定/恩曲他滨（3TC/FTC）+富马酸替诺福韦二吡呋酯（TDF）方案。本研究纳入了2008年10月至2023年8月在意大利米兰圣拉斐尔医院门诊随访的PWH/CHBV患者。基线评估是乙肝激活ART前首次阳性结果后首次乙肝病毒脱氧核糖核酸（HBV-DNA）阴性（<10 IU/mL）的日期。末次评估（LE）是首次乙肝病毒反弹（≥10 IU/mL）或持续乙肝病毒DNA阴性的PWH中最后一次乙肝病毒检测不到的情况。通过多变量逻辑回归估计乙肝病毒反弹的比值比（及相应的95%置信区间），并对最低点CD4细胞、丙氨酸氨基转移酶（ALT）水平以及对两种病毒均有活性的ART进行校正。在153例接受对两种病毒均有活性的ART的PWH/CHBV患者中，25例（16.3%）至少有一次乙肝病毒反弹。在LE时的多变量分析显示，接受3TC/FTC治疗的PWH乙肝病毒反弹的可能性更高[校正比值比，aOR=4.88（95%置信区间，CI=1.28，20.10），p=0.02]，而接受FTC+TAF治疗的PWH乙肝病毒反弹的可能性较低[aOR=0.05（95%CI=0.002，0.27），p=0.005]，两者均与接受3TC/FCT+TDF治疗的患者相比。乙肝病毒反弹与较高的ALT水平相关[aOR=1.03（95%CI=1.01，1.05），每升高1 U/L，p=0.001]。与3TC/FTC+TDF和单独使用3TC/FTC相比，基于FTC+TAF的ART似乎与更好地控制HBV-DNA有关。正如转氨酶水平升高所提示的，乙肝病毒反弹可能对肝脏炎症产生影响。
