International Journal of Clinical Research
International Journal of Clinical Research. 2022; 6: (1) ; 10.12208/j.ijcr.20220025 .
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重庆市第五人民医院 感染性疾病科 重庆
重庆医科大学附属第一医院 重庆
*通讯作者： 钱克莉,单位：重庆医科大学附属第一医院 重庆；
目的 探讨HBsAg定量检测在HIV/HBV共感染者抗病毒治疗过程中的变化。方法 观察随访36例HIV/HBV共感染患者在接受含替诺福韦及拉米夫定方案的抗逆转录病毒治疗后HBsAg及相关指标改变情况。结果 HBeAg阳性患者在治疗2年后HBsAg水平下降0.93 log IU/mL，HBeAg阴性患者仅有0.56 log IU/mL。10例(45%)HBeAg阳性患者治疗后出现HBeAg阴转，其中2例出现HBsAg阴转。HBsAg水平与CD4+T淋巴细胞计数水平相关。抗病毒治疗后CD4+T淋巴细胞计数上升明显患者HBsAg水平下降较明显。结论 HBsAg在治疗早期的下降趋势可以预测HBsAg清除可能以及HBsAg下降与CD4+T淋巴细胞计数水平改变相关性均提示HBsAg水平与患者免疫状态相关。
Objective To investigate the changes of HBsAg in patients coinfected with HBV and human immunodeficiency virus (HIV) who receive antiviral therapy. Methods To observe the changes of HBsAg and related indexes in 36 HBV/HIV co-infected patients after receiving antiretroviral therapy containing tenofovir and lamivudine. Results Baseline and on treatment parameters were associated with longitudinal HBsAg levels. HBeAg–positive patients achieved a decline of 0.93 log IU/mL in HBsAg, whereas HBeAg-negative patients only achieved a decline of 0.56 log IU/mL during 2years of cART. 10(45%) patients of the HBeAg-positive population achieved HBeAg loss and 2(5%) achieved HBsAg loss. HBsAg levels correlated with CD4 T-cell counts. HBsAg levels were significantly lower in patients who had a stronger increase between nadir CD4 and current CD4 T-cell counts during cART. HBsAg decline is dependent on an effective immune status. Conclusion HBsAg kinetics early during treatment were predictive of HBsAg seroclearance and correlated with an increased CD4 T-cell counts, underlining the importance of immune restoration in HBV clearance.
[1] Hepatitis B.: World Health Organization; 2011.
[2] Mallet VO, Dhalluinvenier V, Verkarre V et al. Reversibility of cirrhosis in HIV/HBV coinfection[J]. Antiviral Therapy. 2007, 12(2): 279-283.
[3] Unal ER. HIV–HBV Coinfection — A Global Challenge[J]. New England Journal of Medicine. 2012, 367(24): 1749-1752.
[4] Quasdorff M, Protzer U. Control of hepatitis B virus at the level of transcription[J]. Journal of Viral Hepatitis. 2010, 17(8): 527-536.
[5] Sung JJ, Wong ML, Bowden S et al. Intrahepatic hepatitis B virus covalently closed circular DNA can be a predictor of sustained response to therapy[J]. Gastroenterology. 2005, 128(7): 1890-1897.
[6] Chan HLY, Wong VWS, Tse AML et al. Serum Hepatitis B Surface Antigen Quantitation Can Reflect Hepatitis B Virus in the Liver and Predict Treatment Response[J]. Clinical Gastroenterology & Hepatology the Official Clinical Practice Journal of the American Gastro- enterological Association. 2007, 5(12): 1462-1468.
[7] Werle-Lapostolle B, Bowden S, Locarnini S et al. Persistence of cccDNA during the natural history of chronic hepatitis B and decline during adefovir dipivoxil therapy[J]. Gastroenterology. 2004, 126(7): 1750-1758.
[8] Volz T, Lutgehetmann M, Wachtler P et al. Impaired Intrahepatic Hepatitis B Virus Productivity Contributes to Low Viremia in Most HBeAg-Negative Patients[J]. Gastroenterology. 2007, 133(3): 843-852.
[9] Brunetto MR, Moriconi F, Bonino F et al. Hepatitis B virus surface antigen levels: A guide to sustained response to peginterferon alfa-2a in HBeAg-negative chronic hepatitis B [J]. Hepatology. 2009, 49(4): 1141-1150.
[10] Jaroszewicz J, Calle Serrano B, Wursthorn K et al. Hepatitis B surface antigen (HBsAg) levels in the natural history of hepatitis B virus (HBV)-infection: a European perspective[J]. J Hepatol. 2010, 52(4): 514-522.
[11] Wursthorn K, Jung M, Riva A et al. Kinetics of hepatitis B surface antigen decline during 3 years of telbivudine treatment in hepatitis B e antigen-positive patients[J]. Hepatology. 2010, 52(5): 1611–1620.
[12] Peng, C.Y., et al., Early serum HBsAg level as a strong predictor of sustained response to peginterferon alfa-2a in HBeAg-negative chronic hepatitis B. Aliment Pharmacol Ther, 2012. 35(4): p. 458-68.
[13] Reijnders, J.G., et al., Kinetics of hepatitis B surface antigen differ between treatment with peginterferon and entecavir. J Hepatol, 2011. 54(3): p. 449-54.
[14] Landrum, M.L., et al., The effect of human immune- deficiency virus on hepatitis B virus serologic status in co-infected adults. PLoS One, 2010. 5(1): p. e8687.
[15] Bodsworth, N.J., D.A. Cooper, and B. Donovan, The influence of human immunodeficiency virus type 1 infection on the development of the hepatitis B virus carrier state. J Infect Dis, 1991. 163(5): p. 1138-40.
[16] Chang, T.T., et al., A comparison of entecavir and lamivudine for HBeAg-positive chronic hepatitis B. N Engl J Med, 2006. 354(10): p. 1001-10.
[17] Marcellin, P., et al., Adefovir dipivoxil for the treatment of hepatitis B e antigen-positive chronic hepatitis B. N Engl J Med, 2003. 348(9): p. 808-16.
[18] Lee, J.M., et al., Quantitative hepatitis B surface antigen and hepatitis B e antigen titers in prediction of treatment response to entecavir. Hepatology, 2011. 53(5): p. 1486-93.
[19] Heathcote, E.J., et al., Three-year efficacy and safety of tenofovir disoproxil fumarate treatment for chronic hepatitis B. Gastroenterology, 2011. 140(1): p. 132-43.
[20] Pan, C.Q., et al., Similar efficacy and safety of tenofovir in Asians and non-Asians with chronic hepatitis B. World J Gastroenterol, 2015. 21(18): p. 5524-31.
[21] Wursthorn, K., et al., Kinetics of hepatitis B surface antigen decline during 3 years of telbivudine treatment in hepatitis B e antigen-positive patients. Hepatology, 2010. 52(5): p. 1611-20.
[22] Zoutendijk, R., et al., Serum HBsAg decline during long-term potent nucleos(t)ide analogue therapy for chronic hepatitis B and prediction of HBsAg loss. J Infect Dis, 2011. 204(3): p. 415-8.
[23] Manesis, E.K., et al., Prediction of treatment-related HBsAg loss in HBeAG-negative chronic hepatitis B: a clue from serum HBsAg levels. Antivir Ther, 2007. 12(1): p. 73-82.