Do HIV care providers appropriately manage hepatitis B in coinfected patients treated with antiretroviral therapy?
Do HIV care providers appropriately manage hepatitis B in coinfected patients treated with antiretroviral therapy?
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DOI：
10.1086/512367
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发表时间：
2007-04-01
影响因子：
11.8
通讯作者：
Lee, William M.
中科院分区：
文献类型：
--
作者：
Jain, Mamta K.;Opio, Christopher K.;Lee, William M.
背景。乙型肝炎病毒（HBV）感染常见于携带人类免疫缺陷病毒（HIV）的患者，这要求在适当的时候对这两种病毒进行识别、评估和治疗。从1999年到2003年，我们确定了357例HIV和乙型肝炎表面抗原阳性患者接受了检测；155名新到我们诊所并开始治疗HIV和HBV合并感染的患者被纳入研究。将治疗第一年进行的HIV检测频率（确定HIV载量和CD4（+）细胞计数）与HBV检测频率（确定乙型肝炎e抗原、乙型肝炎e抗原抗体和乙型肝炎病毒载量）、腹部超声检查和血清中甲胎蛋白水平的测量进行比较。在开始抗逆转录病毒治疗（ART）之前，只有16%的患者获得了HBV载量数据，而在开始抗逆转录病毒治疗（ART）之前，99%的患者确定了HIV载量。在开始抗逆转录病毒治疗后的第一年获得的艾滋病毒载量测量总数为497次（每名患者的艾滋病毒载量测量中位数，3.0次），而HBV载量测量为85次（每名患者的HBV载量测量中位数，< 1;P < 0.001）。在开始抗逆转录病毒治疗后接受任何水平的HBV监测（即检测乙型肝炎e抗原、乙型肝炎e抗原抗体和HBV载量）的患者比例从1999年的7%上升到2001年的52% (P < 0.001)，而在同一时期接受HIV载量检测的患者比例保持在80%-90%。1999-2003年期间治疗艾滋病毒感染患者的卫生保健提供者很少监测合并感染患者的HBV反应，但他们在开始抗逆转录病毒治疗后系统地监测艾滋病毒反应。需要提高医生对指南的依从性，更好地描述HIV-HBV合并感染患者的HBV治疗和监测。
Background. The common occurrence of hepatitis B virus (HBV) infection in patients who carry the human immunodeficiency virus (HIV) demands that both viruses be recognized, evaluated, and treated when appropriate.Methods. We identified 357 HIV- and hepatitis B surface antigen-positive patients who underwent testing from 1999 to 2003; 155 patients who were new to our clinic and who initiated therapy for HIV and HBV coinfection were considered for inclusion in the study. The frequency of HIV testing (to determine HIV load and CD4(+) cell count) performed during the first year of therapy was compared with the frequency of HBV measurements (to determine hepatitis B e antigen, antibody to hepatitis B e antigen, and HBV load), abdominal ultrasound examination, and measurement of levels of alpha-fetoprotein in serum.Results. HBV load data were obtained for only 16% of patients before initiation of antiretroviral therapy (ART), whereas HIV load was determined for 99% of patients before initiation of ART. The total number of HIV load measurements obtained during the first year after ART initiation was 497 (median number of HIV load measurements per patient, 3.0), compared with 85 measurements of HBV load (median number of HBV load measurements per patient, < 1; P < .001). The percentage of patients who received any level of HBV monitoring (i.e., tests to determine hepatitis B e antigen, antibody to hepatitis B e antigen, and HBV load) after ART initiation increased from 7% in 1999 to 52% in 2001 (P < .001), whereas the percentage of patients who underwent HIV load testing remained at 80%-90% during the same period.Conclusions. Health care providers treating patients with HIV infection during the period 1999-2003 infrequently monitored HBV response in coinfected patients, but they systematically monitored HIV response after ART initiation. Improved physician adherence to guidelines that better delineate HBV treatment and monitoring for patients with HIV-HBV coinfection is needed.