Zylberberg H, Jiang J, Pialoux G, Driss F, Carnot F, Dubois F, Brechot C, Berthelot P, Pol S
Unité d'Hépatologie, Hôpital Necker, Paris.
Gastroenterol Clin Biol. 1996;20(11):968-71.
A pilot study was conducted to evaluate the efficiency of alpha-interferon treatment in chronic active hepatitis B in anti-HIV-positive patients.
Twenty-five patients with chronic active hepatitis (23 men and 2 women, mean age: 33 years) were included in the study. Viral infections were acquired by intravenous drug addiction in 2, homosexual relations in 22, and multiple heterosexual contacts in one. The mean CD4 cell count was 480 +/- 234/mL, 7 patients had p24 antigenemia, but none belonged to class C of the CDC classification. All patients were serum HBs Ag and HBV DNA-positive, and delta antigen and antibody negative. Patients received a 6-month course of alpha-interferon 2a, 6 MU subcutaneously three times per week. The mean follow-up after treatment was 15 months. Eighteen patients with serum anti-HIV antibodies, HBsAg and HBV DNA-positive, and chronic active hepatitis, who were not treated with interferon, were included as controls (mean follow-up: 29 months).
Nine of the 25 patients (36%) lost serum HBV DNA (1, 2, 4, 6, and 8 months after the beginning of treatment in 1, 4, 1, 2 and 1 cases, respectively), and were considered responders. Only one of the responders developed serum anti-HBe during follow-up, despite the disappearance of HBe Ag in 2 and of HBs Ag in one. Loss of HBV DNA was not clearly associated with the immune status, since 3 of the 9 responders had p24 antigenemia and the 9 responders had a lower mean CD4 count (283 +/- 246/mm3) than non responders (454 +/- 437/mm3, NS). Three of the 18 patients (16.7%) in the control group had spontaneous loss of serum HBV DNA during follow-up. Thus, there was a 2.15-fold increase in HBV DNA loss in the anti-HIV-positive patients who received alpha-interferon, compared to those who did not.
In HIV-positive patients treated with alpha-interferon, the rate of HBV DNA loss was not clearly different from that reported in immunocompetent patients. As severe HBV-related liver disease has previously been described in anti-HIV positive patients, at least in drug users, these results suggest that this treatment may be proposed whatever the immune status, at least in the absence of AIDS.
开展一项试点研究，以评估α干扰素治疗抗HIV阳性患者慢性活动性乙型肝炎的疗效。
25例慢性活动性肝炎患者（23例男性，2例女性，平均年龄：33岁）纳入本研究。2例通过静脉吸毒感染病毒，22例通过同性恋关系感染，1例通过多次异性接触感染。平均CD4细胞计数为480±234/mL，7例患者有p24抗原血症，但均不属于美国疾病控制与预防中心（CDC）分类的C类。所有患者血清乙肝表面抗原（HBs Ag）和乙肝病毒DNA（HBV DNA）均为阳性，丁型抗原和抗体均为阴性。患者接受为期6个月的α干扰素2a疗程治疗，每周皮下注射3次，每次6百万单位（MU）。治疗后的平均随访时间为15个月。18例血清抗HIV抗体、HBsAg和HBV DNA阳性且患有慢性活动性肝炎但未接受干扰素治疗的患者作为对照（平均随访时间：29个月）。
25例患者中有9例（36%）血清HBV DNA转阴（分别在治疗开始后1、2、4、6和8个月各有1、4、1、2和1例转阴），被视为治疗有效者。随访期间，9例治疗有效者中只有1例出现血清抗HBe，尽管有2例HBe抗原消失，1例乙肝表面抗原消失。HBV DNA转阴与免疫状态无明显关联，因为9例治疗有效者中有3例有p24抗原血症，且9例治疗有效者的平均CD4计数（283±246/mm³）低于未转阴者（454±437/mm³，无统计学差异）。对照组18例患者中有3例（16.7%）在随访期间血清HBV DNA自发转阴。因此，接受α干扰素治疗的抗HIV阳性患者的HBV DNA转阴率比未接受治疗者增加了2.15倍。
在接受α干扰素治疗的HIV阳性患者中，HBV DNA转阴率与免疫功能正常患者的报道率无明显差异。由于此前已报道抗HIV阳性患者中存在严重的HBV相关肝病，至少在吸毒者中如此，这些结果表明，无论免疫状态如何，至少在无艾滋病的情况下，均可考虑进行这种治疗。
