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合并慢性乙型肝炎病毒感染的HIV感染者的监测

Author
Kenneth E Sherman, MD, PhD
Section Editor
David L Thomas, MD
Deputy Editor
Jennifer Mitty, MD, MPH
Translators
秦波, 主任医师，教授

引言

强效抗逆转录病毒治疗(antiretroviral therapy, ART)时代已使机会性感染的发生率下降，以及使并发症的其他主要原因成为新焦点，如继发于慢性乙型肝炎病毒(hepatitis B virus, HBV)感染的终末期肝病(end-stage liver disease, ESLD)[1]。鉴于人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染对慢性HBV感染自然病程的负面影响，HBV的治疗和预防具有十分重要的意义。ART适用于所有HBV共感染的患者，三种抗HIV药物(替诺福韦、恩曲他滨及拉米夫定)中的两种应具有抗HIV和HBV的双重活性[2]。

然而，HIV感染者的HBV治疗可因药物诱导性肝毒性、免疫重建综合征和药物相关毒性而变得复杂。此外，不管患者是否接受治疗，需要监测是否发生肝细胞癌。

本专题将讨论HIV/HBV共感染患者的监测，无论其是否接受抗病毒治疗。HIV感染者中HBV感染的流行病学、临床表现、诊断、处理和预防将单独讨论。 (参见“HIV感染者中乙型肝炎的流行病学、临床表现和诊断”和“HIV感染者中慢性乙型肝炎病毒感染的治疗前评估”和“艾滋病病毒感染者慢性乙型肝炎的治疗”和“HIV感染成人的乙型肝炎病毒感染预防”)

HBV治疗期间的患者监测

HBV DNA和转氨酶监测 — 在HBV治疗期间，实验室监测包括连续转氨酶和病毒抑制评估。一些专家推荐每3个月监测1次HBV DNA和转氨酶水平[3]。

频繁监测HBV DNA(即，每3个月1次)有助于早期发现耐药性的出现，耐药性可导致肝病发作。对于接受稳定方案和预期依从性较高的患者，每6个月监测1次可能就已足够。 (参见下文‘HBV耐药性检测’)

                

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Literature review current through: 2017-06 . | This topic last updated: 2015-01-08.
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