基于拉米夫定的治疗方案对HIV/HBV合并感染者HBV耐药的影响  

Impact of lamivudine-based antiretroviral therapy on hepatitis B virus(HBV)resistance mutations among HIV/HBV coinfected patients

作　　者：吴亚松[1] 邓晓军 张伟伟[1] 鲁鸿燕[3] 魏飞力 杨炼 马烨[1] 刘中夫[1] 张福杰[5] 

机构地区：[1]中国疾病预防控制中心性病艾滋病预防控制中心,北京102206 [2]衡阳市第三人民医院,湖南衡阳421005 [3]广西壮族自治区疾病预防控制中心,南宁530028 [4]北京市肝病研究所,北京100069 [5]首都医科大学附属北京地坛医院感染科,北京100015

出　　处：《中国艾滋病性病》2016年第6期407-409,432,共4页Chinese Journal of Aids & STD

基　　金：中美艾滋病防治合作项目(活动编号7.11);国家科技重大专项(2014ZX10001002)~~

摘　　要：目的研究拉米夫定(3TC)为基础的抗反转录病毒治疗(ART)对艾滋病病毒和乙型肝炎(简称乙肝)病毒(HIV/HBV)合并感染者HBV耐药的影响。方法依托既往建立的使用仅3TC有抗HBV作用ART方案的HIV/HBV合并感染队列,选择进入队列时HBV DNA>1000拷贝/mL感染者,选取治疗48周前后采集的血浆标本,用测序法检测HBV耐药,分析48周前后HBV耐药突变。结果进入队列时艾滋病初治和经治患者分别为5例和14例,6例经治患者有HBV耐药突变。48周后,5例初治患者和6例经治患者获得乙肝病毒学应答,8例经治患者HBV未被抑制,其中4例出现新的HBV耐药突变。结论对初治HIV/HBV合并感染,基于仅3TC有抗HBV作用的ART短期内对HBV有较好抑制作用,长期治疗应优先选择含3TC和替诺福韦(TDF)的方案。Objective To evaluate the impact of lamivudine（3TC）based combination antiretroviral therapy（ART）on the hepatitis B viral（HBV）resistance mutations in HIV/HBV coinfected individuals.Methods 19 human immunodeficiency viral（HIV）/HBV coinfected individuals were included,who were treated with lamivudine based combination antiretroviral therapy and having HBV DNA〉1000copies/mL at baseline.Mutational analysis of the RT-region was done by sequencing followed by genotyping.HBV resistance mutations at baseline and after 48 weeks of ART were analyzed.Results At baseline,no HBV resistance were detected in 5nave patients.Six of 14 experienced patients had HBV with lamivudine resistance mutations.After 48 weeks,none of nave patients and 8experienced patients was with HBV DNA higher than 1000copies/mL.Four patients developed new resistance mutations.Conclusion 3TC based ART is effective for HBV in HIV/HBV coinfected nave patients in short-term.TDF and 3TC based ART should be used for long term treatment for HIV/HBV coinfection.

关 键 词：乙型肝炎 艾滋病病毒 拉米夫定 耐药 

分 类 号：R512.91[医药卫生—内科学] R373.9[医药卫生—临床医学]