拉米夫定联合替诺福韦治疗艾滋病合并慢性病毒性乙型肝炎的临床和实验研究

Clinical and experimental studies of combination therapy with lamivudine and tenofovir in one patient co-infected with HIV-1 and hepatitis B virus

目的探讨拉米夫定（3TC）联合替诺福韦（TDF）治疗重症艾滋病（AIDS）合并慢性病毒性乙型肝炎（CHB）患者的疗效。方法收集患者住院治疗及随访阶段的实验室检查数据。高效抗反转录病毒（HAART）治疗前及治疗后24周、28周留取患者血标本，用巢式PCR扩增HBVP基因区，反转录．巢式PCR扩增HIV pol基因区，分析HBV及HIV是否发生耐药。结果患者随访1年身体状况佳，主要实验室检查基本正常，未发现HBV相关耐药，HIVRNA扩增结果为阴性。结论联合3TC与TDF两种药物的HAART方案能在短期内达到对HIV和HBV两种病毒的抑制，临床疗效显著。

Objective To investigate the therapeutic effect of combination therapy with lamivudi- ne（3TC） and tenofovir（TDF） in one patient coinfected with HIV-1 and hepatitis B virus who suffered with severe immunodeficiency and severe liver disease. Methods We collected hospitalization data and follow-up laboratory examination of the patient to analyze the clinical effect of drugs. Nested PCR and re- verse transcriptase-nested PCR amplification were used to analysed HBV P gene and HIV pol gene region to explore whether drug-resistant of HBV and HIV had existed. The blood samples were collected before highly active anti-retroviral therapy （HAART）and 24 weeks, 28 weeks after HAART. Results Patients were followed up 1 year with good physical condition, normal laboratory examinations. We did not find any HBV-related drug resistance, HIV RNA PCR was negative. Conclusion HAART including TDF and 3TC can achieve complete suppression of both viruses in the short term. The clinical effect is significant.