不同HBV基因型HIV/HBV合并感染者临床特征及抗病毒治疗效果比较

Comparison of the clinical characteristics and antiviral treatment effect of HIV/HBV co-infected patients with different HBV genotypes

目的了解不同HBV基因型HIV/HBV合并感染者的临床特征及抗逆转录病毒治疗(antiretroviral therapy,ART)效果,探讨HBV基因型对HIV/HBV合并感染可能存在的影响。方法以2009—2020年广州医科大学附属市八医院感染门诊HIV/HBV合并感染者为研究对象,比较B型和C型HBV感染者的临床特征及ART后病毒学、免疫学与临床应答。结果患者纳入研究共722例,HBV分型:B型496例(68.70%)、C型220例(30.47%)、D型2例(0.28%)和I型4例(0.55%)。B型患者的基线HBV DNA载量和HBeAg阳性比例分别为6.29 lg IU/mL和36.49%(181/496),均低于C型患者;HBsAg定量水平为5478.50 COI,高于C型患者(Z=-2.989,P=0.003;χ^(2)=31.680,P<0.001;Z=-0.848,P<0.001)。两组患者使用包含替诺福韦和拉米夫定方案的比例均≥95%,平均ART治疗4.17年后,两组患者HIV和HBV病毒抑制率均>94%。B型患者在随访期间的HBsAg阴转率为7.25%(36/496),高于C型患者(χ^(2)=5.291,P=0.021)。B型患者ART后HBsAg下降值为372.00 COI,高于C型患者(Z=-0.018,P=0.032)。结论广东省HIV/HBV合并感染者HBV基因型以B型和C型为主,接受ART后均可获得较好病毒抑制与免疫重建,但C型患者HBsAg转阴率低于B型,提示不同HBV基因型可能影响合并感染者的HBV治愈。

Objective:To investigate the clinical characteristics and antiretroviral therapy(ART)outcomes in HIV/HBV co-infected patients with different HBV genotypes,and to explore the potential impact of HBV genotypes on HIV/HBV co-infection.Methods:HIV/HBV co-infected patients attending the infectious disease outpatient clinic at Guangzhou Eighth People's Hospital,Guangzhou Medical University from 2009 to 2020 were enrolled.Clinical characteristics and virological,immunological,and clinical responses after ART were compared between genotype B and C HBV-infected patients.Results:A total of 722 patients were included in the study,among whom 496 cases(68.70%)were HBV genotype B,220 cases(30.47%)were genotype C,2 cases(0.28%)were genotype D,and 4 cases(0.55%)were genotype I.Baseline HBV DNA load and HBeAg positive rate in genotype B patients were 6.29 lg IU/mL and 36.49%(181/496),respectively,which were both lower than those in genotype C patients;and HBsAg quantitative level was 5478.50 COI,which was higher than that in genotype C patients(Z=-2.989,P=0.003;χ^(2)=31.680,P<0.001;Z=-0.848,P<0.001).The proportions of patients in both groups receiving ART containing tenofovir disoproxil fumarate and lamivudine were≥95%.After an average of 4.17 years of ART,virological suppression rates for HIV and HBV were both>94%in genotype B and C groups.The rate of HBsAg seroconversion during follow-up period was 7.25%(36/496)in genotype B patients,which was higher than that in genotype C patients(χ^(2)=5.291,P=0.021).Compared with patients with genotype C,patients with genotype B had higher HBsAg decline of 372.00 COI(Z=-0.018,P=0.032).Conclusions:Genotype B and C are predominant in HIV/HBV co-infected individuals in Guangdong Province.All patients with genotype B or C can achieve excellent viral suppression and immune reconstruction after ART.However,genotype C individuals have a lower HBsAg seroconversion rate than genotype B individuals,which indicates that different HBV genotypes may affect the HBV cure in HIV/HBV co-infected patients.