Annals of internal medicne:HIV治疗可为携带者提供额外福利

  (HBV病毒电镜照片 图片来源：美国疾控中心)

2015年10月19日讯 /生物谷BIOON/ --在一项包含2,400名曾进行过男男性行为的男性研究中，研究人员发现相比于携带HIV但没有接受治疗或虽然进行了HIV治疗但仍然可检测到病毒的男性来说，携带HIV并通过HIV治疗方法得到有效治疗的男性更不易受到乙肝病毒（hepatitis B virus ，HBV）感染。早先对HIV个体的研究也表明HIV治疗药物中一些也可以对抗乙肝病毒的药物能够降低造成肝损伤的乙肝病毒的感染风险。

事实上，得到HIV有效治疗的男性与不携带HIV病毒的男性受到HBV感染的风险相同。

近日，相关研究结果发表在国际学术期刊Annals of Internal Medicine上，参与这项研究的男性在研究伊始并没有受到乙肝病毒感染。

研究人员Chloe Thio这样说道："这项研究告诉我们有效的HIV治疗似乎可以重建免疫应答反应，保护HIV携带者避免受到乙肝病毒感染。"这项研究还证实了之前已知的一项发现，无论HIV感染状态如何，接种预防乙肝病毒的疫苗都能够保护接种者避免受到新的乙肝病毒感染。

另一位研究人员指出，至少接受过单剂量乙肝病毒疫苗注射的男性中受到新的乙肝病毒感染的情况下降了70%，但疫苗接种率即使是在高风险人群中，比如与同性发生性行为的男性，也仍然很低，因此我们还需要做更多努力鼓励大家接种疫苗。

在1984年这项研究开始的时候，有41%携带HIV的男性接种过抗乙肝病毒疫苗，而不携带HIV病毒的男性中之后28%接种过抗乙肝病毒疫苗；而到该项研究结束的时候，参与研究的男性中至少接种过单剂量HBV疫苗的比例达到60%，携带和不携带HIV病毒的男性接种乙肝病毒疫苗的比例分别为67%对58%。

而根据美国疾病防控中心的提示，成年人应该在6个月内接种三剂量抗乙肝病毒疫苗。（生物谷Bioon.com）

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doi:10.7326/M15-0547

Incident Hepatitis B Virus Infection in HIV-Infected and HIV-Uninfected Men Who Have Sex With Men From Pre-HAART to HAART Periods: A Cohort Study

Oluwaseun Falade-Nwulia, MD, MPH; Eric C. Seaberg, PhD; Anna E. Snider; Charles R. Rinaldo, PhD; John Phair, MD; Mallory D. Witt, MD; and Chloe L. Thio, MD

Background: Men who have sex with men (MSM) are at high risk for hepatitis B virus (HBV) infection. Data on the effect of highly active antiretroviral therapy (HAART) on incident HBV infection in HIV-infected and HIV-uninfected MSM are limited.

Objective: To determine predictors of incident HBV infection in MSM during pre-HAART and HAART periods.

Design: Observational cohort study.

Setting: Cohort of MSM who have, or are at risk for, HIV infection.

Patients: 2375 HBV-uninfected MSM in the Multicenter AIDS Cohort Study.

Measurements: Poisson regression was used to compare incidence rates of HBV infection in the pre-HAART and HAART eras and to identify factors associated with incidence of HBV infection.

Results: In 25 322 person-years of follow-up, 244 incident HBV infections occurred. The unadjusted incidence rate was higher in HIV-infected MSM than in HIV-uninfected MSM (incidence rate ratio [IRR], 1.9 [95% CI, 1.5 to 2.4]) and was significantly lower in the HAART era than in the pre-HAART era among HIV-infected (IRR, 0.2 [CI, 0.1 to 0.4]) and HIV-uninfected (IRR, 0.3 [CI, 0.2 to 0.4]) MSM. Age younger than 40 years (IRR, 2.3 [CI, 1.7 to 3.0]), more than 1 recent sexual partner (IRR, 3.1 [CI, 2.3 to 4.2]), and HIV infection (IRR, 2.4 [CI, 1.8 to 3.1]) were independently associated with higher incidence of HBV infection, whereas HBV vaccination was protective (IRR, 0.3 [CI, 0.2 to 0.4]). Highly active antiretroviral therapy with HIV RNA levels less than 400 copies/mL was associated with protection (IRR, 0.2 [CI, 0.1 to 0.5]), but HAART in those with HIV RNA levels of 400 copies/mL or greater was not.

Limitation: The observational nature limits inferences about causality.

Conclusion: Effective HAART is associated with lower incidence of HBV infection; however, even in the HAART era, incidence of HBV infection remains high among MSM.