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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 investigate the impact of lamivudine (3TC) -based ART on HBV resistance in patients with HIV and HBV infection. Methods Based on the cohort of HIV / HBV co-infected patients who had established the ART program with only 3TC anti-HBV effect, we selected plasma samples collected before and after 48 weeks of HBV DNA> 1000 copies / mL when entering the cohort and were sequenced HBV resistance, analysis of HBV resistance mutations after 48 weeks. Results When entering the cohort, 5 cases and 14 cases of newly diagnosed and treated AIDS patients, respectively, and 6 treated patients had HBV resistance mutations. After 48 weeks, 5 patients with newly diagnosed and 6 treated patients received HBV virological response. HBV was not inhibited in 8 treated patients, and 4 new HBV resistant mutants were found. CONCLUSIONS: In the first trimester of HIV / HBV co-infection, ART with 3TC-only anti-HBV effect may have a short-term inhibitory effect on HBV. Long-term treatment should give priority to 3TC and tenofovir (TDF) regimens.