Chronic active hepatitis B exacerbations in human immunodeficiency virus-infected patients following development of resistance to or withdrawal of lamivudine
Chronic active hepatitis B exacerbations in human immunodeficiency virus-infected patients following development of resistance to or withdrawal of lamivudine
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DOI：
10.1086/514750
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发表时间：
1999-05-01
影响因子：
11.8
通讯作者：
Sherman, KE
中科院分区：
文献类型：
--
作者：
Bessesen, M;Ives, D;Sherman, KE
拉米夫定是一种核苷类似物，具有抗人类免疫缺陷病毒 (HIV) 和乙型肝炎病毒 (HBV) 的活性。当拉米夫定治疗停止或 HBV 对拉米夫定出现耐药性时，HN 和 HBV 合并感染的患者可能会出现肝炎发作。这项在三个三级医疗中心进行的回顾性描述性研究描述了同时感染 1 型 HIV 和 HBV 的患者，这些患者对拉米夫定戒断或耐药表现出一系列临床和亚临床肝炎反应。当停止拉米夫定治疗并代之以更有效的抗逆转录病毒治疗方案时，一名患者出现暴发性肝衰竭，另一名患者出现亚临床肝炎。三名患者在拉米夫定治疗 13 至 18 个月后出现肝炎发作。 HIV 和 HBV 合并感染患者拉米夫定停药或出现拉米夫定耐药突变体可能导致严重肝炎。护理 HPV 和 HEV 合并感染患者的临床医生应意识到，先前无症状的携带者患者可能会出现乙型肝炎发作。
Lamivudine is a nucleoside analog with activity against human immunodeficiency virus (HIV) and hepatitis B virus (HBV). Patients coinfected with HN and HBV may have hepatitis flares when lamivudine therapy is discontinued or when resistance of HBV to lamivudine emerges. This retrospective, descriptive study conducted in three tertiary cam medical centers describes patients coinfected with HIV type 1 and HBV who presented with a spectrum of clinical and subclinical hepatitic responses to lamivudine withdrawal or resistance. One patient had fulminant hepatic failure and a second patient had subclinical hepatitis when lamivudine therapy was discontinued and a more efficacious antiretroviral regimen was substituted. Three patients had flares of hepatitis after 13 to 18 months of lamivudine therapy. Lamivudine withdrawal or emergence of lamivudine-resistant mutants in patients coinfected with HIV and HBV may result in severe hepatitis. Clinicians caring for patients with coinfection with HPV and HEV should be aware of the possibility that a hepatitis B flare may occur in previously asymptomatic carrier patients.