替诺福韦治疗期间HIV / HBV合并感染的HBsAg清除率

StephenW

FREQUENT HBsAg CLEARANCE DURING TENOFOVIR THERAPY IN HIV/ HBV COINFECTION

CROI 2021 March 6-10 Reported by Jules Levin

Charles Béguelin , Bernard Surial , Eveline Hofmann , Matthias Cavassini , Huldrych F. Günthard , Manuel Battegay , Enos Bernasconi , Patrick Schmid , Alexandra L. Calmy , Franziska Suter-Riniker , Andri Rauch , Gilles Wandeler , for
the Swiss HIV Cohort Study UniversityHospitalofBern,Bern,Switzerland, LausanneUniversityHospital, Lausanne,Switzerland, UniversityHospitalZurich,Zurich,Switzerland, University HospitalBasel,Basel,Switzerland, RegionalHospitalofLugano,Lugano, Switzerland, CantonalHospitalofStGallen,StGallen,Switzerland, University HospitalsofGeneva,Geneva,Switzerland, UniversityofBern,Bern,Switzerland

Background: Among persons with hepatitis B virus (HBV)-monoinfection, loss of the hepatitis B surface antigen (HBsAg), also described as HBV functional cure, is a rare event but associated with reduced incidence of liver-related complications. We aimed to assess the proportion of HBV functional cure among persons with HIV/HBV-coinfection during long-term tenofovir-therapy who experienced HBV functional cure, and to evaluate the association between quantitative HBsAg (qHBsAg) levels and this outcome.

Methods: All Swiss HIV Cohort Study participants with two positive HBsAg more than 6 months apart, and at least 4 years on tenofovir-containing antirertroviral therapy (ART) were considered. Our main outcomes were the loss of HBsAg during the first 2 years of tenofovir therapy and until the last available follow-up. We explored the association between qHBsAg levels at tenofovir start and HBsAg loss using multivariable logistic regression adjusted for gender, age, ethnicity, HIV transmission group, CD4 count (<350/μl), as well as for HBV suppression (<20 IU/mL) and low qHBsAg (<1000 IU/mL) at tenofovir start.

Results: A total of 272 patients were included. Median age was 41 years (IQR 36-46) and 221 (81%) were men. At tenofovir start, 110 (49%) patients were hepatitis B envelope antigen (HBeAg) positive, 229 (84%) had detectable HBV-DNA (median 1050 IU/ml, IQR 89-1.1x10E6) and 21% had low qHBsAg. HBsAg loss was observed in 8% (19/230) of participants during the first 2 years of tenofovir-containing ART and in 16% (43/262) of them after a median follow-up time of 8.4 years (IQR 2.6-15.8). At the last follow up, 54% (16/27) of those with HBsAg loss seroconverted for Anti-HBs antibodies. In multivariable analysis, low qHbsAg at tenofovir start (OR 12.01, CI 2.50-57.71) as well as female gender (OR 9.15, CI 1.08-77.45) were significant predictors of HBsAg loss, whereas this outcome was less likely among participants with negative baseline HBV DNA (OR 0.14, CI 0.02-0.79).

Conclusion: We found high rates of HBsAg loss in PLWH coinfected with HBV on tenofovir-containing ART, and baseline quantitative HBsAg level was a strong predictor of this outcome.

StephenW

替诺福韦治疗期间HIV / HBV合并感染的HBsAg清除率

CROI 2021年3月6日至10日，Jules Levin报告

CharlesBéguelin，Bernard Surial，Eveline Hofmann，Matthias Cavassini，HuldrychF.Günthard，Manuel Battegay，Enos Bernasconi，Patrick Schmid，Alexandra L.Calmy，Franziska Suter-Riniker，Andri Rauch，Gilles Wandeler
瑞士艾滋病毒队列研究大学，伯尔尼医院，瑞士洛桑大学，瑞士洛桑大学医院，瑞士苏黎世，瑞士苏黎世大学医院，巴塞尔大学，瑞士巴塞尔，瑞士巴塞尔，瑞士地区医院，卢加诺医院，卢加诺，瑞士，日内瓦瑞士，日内瓦医院，StGlen大学，瑞士日内瓦州，瑞士医院，伯尔尼，瑞士

背景：在患有乙型肝炎病毒（HBV）单一感染的人中，乙型肝炎表面抗原（HBsAg）的丢失（也被称为HBV功能性治愈）是罕见的事件，但与肝脏相关并发症的发生率降低相关。我们旨在评估长期替诺福韦治疗期间经历过HBV功能治愈的HIV / HBV合并感染者中HBV功能治愈的比例，并评估定量HBsAg（qHBsAg）水平与该结果之间的关联。

方法：所有瑞士HIV队列研究参与者均被认为两个HBsAg阳性之间的间隔时间均超过6个月，并且至少接受了含替诺福韦抗逆转录病毒治疗（ART）的4年。我们的主要结局是在替诺福韦治疗的前2年以及直至最后的随访中HBsAg丢失。我们使用针对性别，年龄，种族，HIV传播组，CD4计数（<350 /μl）和HBV抑制（<20 IU / mL）调整的多变量logistic回归研究了Tenofovir开始时qHBsAg水平与HBsAg丧失之间的关系。 ）和替诺福韦开始时的低qHBsAg（<1000 IU / mL）。

结果：共纳入272例患者。中位年龄为41岁（IQR 36-46），男性为2​​21（81％）。在替诺福韦治疗开始时，有110名（49％）患者的乙型肝炎包膜抗原（HBeAg）阳性，有229名（84％）的患者可检测到HBV-DNA（中位数1050 IU / ml，IQR 89-1.1x10E6），而21％的患者的qHBsAg低。在接受含替诺福韦的ART的前两年中，有8％（19/230）的参与者观察到HBsAg丢失，在中位随访时间为8.4年之后（IQR 2.6-15.8），其中有16％（43/262）的参与者出现了HBsAg丢失。 ）。在最后一次随访中，HBsAg丢失者中有54％（16/27）血清转化为抗HBs抗体。在多变量分析中，替诺福韦开始时qHbsAg低（OR 12.01，CI 2.50-57.71）以及女性（OR 9.15，CI 1.08-77.45）是HBsAg丢失的重要预测指标，而基线阴性的参与者这一结果的可能性较小HBV DNA（OR 0.14，CI 0.02-0.79）。

结论：我们发现在含有替诺福韦的抗病毒药合并感染HBV的PLWH中，HBsAg的流失率很高，而基线定量HBsAg水平是这一结果的有力预测指标。

StephenW

这些结果是出乎意料的 , 我想知道它们是否归因于HIV抗逆转录病毒疗法(ART)中的其他药物 .

lancas

有这么高么？这也算是个好消息

乙肝人1949

你要再感染上艾滋病，然后乙肝，艾滋病一块冶？

乙肝人1949

脑回路，十分清奇

小牡丹

用治疗艾滋的残羹剩饭来治疗乙肝，可以顺便想一想。把这样的思路用于治疗乙肝，方向不对头。乙肝与艾滋是完全不同的两种病毒造成的，一种人体可以自愈，另一种则人体无奈。正确的乙肝治疗方法，应该是研究自愈的人为什么能自愈。祖国伟大的生物学家不是不明白，而是利欲熏心，不想辛苦为别人做嫁衣。特色不好