TDF、3TC、EFV联合治疗HIV合并HBV感染的临床疗效

Clinical curative effect of combined application of TDF, 3TC and EFV in treatment of HIV complicated with HBV infection

探讨替诺福韦（TDF）、拉米夫定（3TC）、依非韦伦（EFV）联合治疗艾滋病病毒（HIV）合并乙型肝炎病毒（HBV）感染的疗效及安全性。对2011年6月~2013年6月首次来我院门诊就诊的38例HIV合并HBV患者进行随访研究，所有患者均给予TDF、3TC、EFV联合抗病毒治疗，分别于治疗前，治疗后第3、6及12个月对患者的HIV RNA载量、HBV DNA载量、CD4＋T细胞计数、HBeAg血清学转换等指标进行比较分析。38例中，31例完成随访，患者治疗后第3、6、12个月的HIV RNA转阴率分别为19.4%、80.6%、100%，HBV DNA转阴率分别为77.4%、96.8%、100%。患者治疗后CD4＋T细胞计数与治疗前相比均明显提高（P〈0.01）；血肌酐与治疗前相比虽显著升高（P〈0.01），但均在正常范围之内。12例HBeAg阳性患者中，治疗3个月后，4例（33.3%）出现血清学转阴；治疗后患者血丙氨酸转氨酶水平与治疗前相比均明显改善（P〈0.01）。TDF、3TC、EFV联合治疗HIV合并HBV感染疗效确切，可提高血清病毒转阴率及CD4＋T细胞水平，安全可靠。

9 To explore the curative effect and safety of combined application of tenofovir （TDF）, Lamivudine （3TC） and Efavirenz （EFV） in treatment of human immunodeficiency virus （HIV） complicated with hepatitis B virus （HBV）. Total 38 patients with HIV complicated with HBV to receive treatment in our hospital for the first time from June 2011 to June 2013 were selected for the follow-up studies. All of them received the combined antiviral treatment with TDF, 3TC and EFV. The indexes, such as the HIV RNA load, HBV DNA load, CD4＋T cell number and HBeAg seroconversion, were compared and analyzed before the treatment and in the 3rd, 6th and 12th month after the treatment respectively. Among 38 patients, 31 ones completed the follow-up. In the 3rd month, 6th month and 12th month after the treatment, the negative conversion rate of HIV RNA was 19.4%, 80.6%and 100%, respectively, while the negative conversion rates of HBV DNA was 77.4%, 96.8%and 100%. Compared with before the treatment, after the treatment, the CD4＋T cell number increased significantly （P〈 0.01）; although the serum creatinine also increased, they remained within the normal range. In 12 patients with positive HBeAg, four patients （33.3%） turned into negative in serology after 3-month treatment; compared with the levels before the treatment, the alanine transarninase （ALT） level got improved significantly after the treatment （ P〈 0.01）. The combined application of TDF, 3TC and EFV can achieve a definite curative effect in treatment of HIV complicated with HBV infection and elevate the negative conversion rate of serum virus and CD4＋T cell levels. So it is a safe and reliable therapy.