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目的探讨HBV合并HIV感染的抗病毒治疗。方法使用核苷(酸)类似物和干扰素药等两种药物治疗对照患者的临床资料。结果治疗HIV,不治疗HBV;为了今后用药,暂不用拉米夫啶,不能单用核苷类药物治疗;治疗HBV,不治疗HIV;可用阿德福韦或干扰素(最好用乙酰二聚化干扰素),勿用拉米夫啶;治疗HIV和HBV;可用拉米夫啶。建议多种核苷类联合应用。当HBV感染需要治疗而HIV感染不需要时,根据CD4计数(>350个/mm3)选择治疗方案,应考虑选用对HIV无作用的药物,如PEG-IFN、阿德福韦酯或替比夫定。恩替卡韦对HIV存在残余活性且具有潜在筛选M184V耐药变异风险而不推荐使用。合并感染者若表现为CD4计数较高,HBeAg阳性,ALT升高、血清HBV-DNA低载量和轻度肝纤维化特别是HBV基因A型者,推荐12个月疗程的PEG-IFN治疗,超过1/3在停药后表现为持续HBV-DNA抑制。
Objective To investigate the antiviral treatment of HBV with HIV infection. Methods The clinical data of two control drugs, nucleoside (acid) analogues and interferon, were compared. The results of treatment of HIV, not treatment of HBV; for future medication, temporarily without lamivudine, can not be treated with nucleoside drugs alone; treatment of HBV, not treatment of HIV; available adefovir or interferon (preferably with acetyl dimerization Interferon), do not use lamivudine; treatment of HIV and HBV; lamivudine available. Proposed a variety of nucleosides combined application. When HBV infection requires treatment and HIV infection is not required, treatment options should be considered based on CD4 counts (> 350 / mm3) and should be considered for non-HIV drugs such as PEG-IFN, adefovir or telbivud set. Entecavir has residual activity against HIV and is not recommended for potential screening of M184V resistant variants. A 12-month course of PEG-IFN treatment is recommended for patients with co-infection who present with high CD4 counts, HBeAg-positive, elevated ALT, low serum HBV-DNA load, and mild liver fibrosis, especially HBV genotype A, Over one-third showed persistent HBV-DNA suppression after discontinuation.