Virologic and Serologic Outcomes of Persons with HIV and HBV co-infection on Mono

HIV 和 HBV 混合感染者的病毒学和血清学结果

• 批准号: 7860348
• 负责人: JUDITH Ann ABERG
• 金额: $ 16.9万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-05 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7860348
• 关键词: AIDS clinical trial group; Anti-Retroviral Agents; Antibodies; Antiretroviral drug resistance; Antiviral Agents; Antiviral Therapy; Blood specimen; Carrier State; Chronic Hepatitis; Cirrhosis; Clinical Trials; Combined Modality Therapy; Data; Development; Disease; Disease Progression; Drug resistance; Effectiveness; Expert Opinion; Exposure to; Failure; Future; Genotype; Guidelines; Hepatitis; Hepatitis B; Hepatitis B Virus; Hepatitis B e Antigens; Hepatitis C virus; Hepatitis D; Human; Immunologic Deficiency Syndromes; Incidence; Infection; Kinetics; Lamivudine; Learning; Link; Liver; Liver Fibrosis; Measures; Mono-S; Morbidity - disease rate; Mutation; Opportunistic Infections; Outcome; Pathogenesis; Patients; Persons; Pharmaceutical Preparations; Phase; Primary carcinoma of the liver cells; Prognostic Marker; Publishing; Randomized; Recommendation; Regimen; Resistance; Retrospective Studies; Risk; Sampling; Serological; Simian B disease; Specific qualifier value; Staging; Tenofovir; Testing; Time; United States Dept. of Health and Human Services; Viral; Viral Drug Resistance; Viral Load result; Viremia; Virus Diseases; anti-hepatitis B; antiretroviral therapy; base; clinically relevant; cohort; drug development; emtricitabine; experience; follow-up; mortality; outcome forecast; prevent; prospective; public health relevance; randomized trial; repository; resistance mutation; response; treatment strategy; viral DNA

DESCRIPTION (provided by applicant): An estimated 36 million people worldwide have HIV infection, while over 300 million have HBV infection. Among those with HBV mono-infection, HBe seroconversion from the state of Hepatitis B e antigen (HBeAg) positive chronic hepatitis to an "inactive" or "carrier" state (HBeAg negative) has historically been considered to mark a change in HBV infection phase or stage and results in a better prognosis. Patients who experience spontaneous HBeAg seroconversion can have reduction in hepatic fibrosis and "inactive carrier status" patients have more favorable outcomes, with lower incidence of cirrhosis and hepatocellular carcinoma (HCC). The association of HBeAg seroconversion with better outcome may be due to its association with reduction in HBV viral load as HBV DNA level has been shown to be independently associated with risk of HCC. When compared with HBV mono-infection, HIV-HBV co-infection increases risk of liver-related mortality. However there is little information on the virologic and serologic outcomes of those with HIV-HBV coinfection. National HIV guidelines recommend the initiation of HIV antiretroviral therapy (ART) that includes 2 active HBV agents in order to prevent development of drug resistance to HBV. Yet some experts argue that there is insufficient data to warrant dual HBV therapy immediately and that it is reasonable to sequence a second HBV agent if monotherapy does not suppress HBV after 48-96 weeks. Furthermore, limited data suggest that persons with HIV-HBV coinfection are less likely to achieve HBV viral suppression and less likely to lose HBeAg and develop anti-HBe. The AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized Trials (ALLRT) study is a well characterized cohort of 4371 HIV-infected subjects who have been prospectively randomized to receive ART and have stored samples at a central repository. We therefore propose to identify those subjects with active HBV infection among this ideal cohort and as our primary objective compare the time to HBV virologic suppression and change in HBeAg/anti- HBe status among those who receive 2 HBV active agents compared with those who receive one HBV active agent over a 5 year period. We will also evaluate for Hepatitis D co-infection, genotype for markers of prognosis and perform resistance testing on those who never suppress or have rebound HBV viremia on therapy. Further characterizing the disease course of HIV-HBV coinfection will assist in development of future pathogenesis studies and treatment interventional trials. PUBLIC HEALTH RELEVANCE: Hepatitis B Virus (HBV) infection is a significant cause of morbidity and mortality among those with Human Immunodeficiency Viral (HIV) infection. There is limited data on the effectiveness of combination therapies used to treat both HIV and HBV compared with HIV therapies that contain only one active drug against HBV. This proposal will examine the effectiveness of HBV treatment by measuring hepatitis markers and the amount of Hepatitis B virus in stored blood samples from HIV-HBV coinfected patients who participated in prospective, longitudinal randomized HIV clinical trials.

描述（由申请人提供）：全球估计有3600万人感染艾滋病毒，而超过3亿人感染乙型肝炎病毒。在HBV单一感染患者中，HBe血清从乙型肝炎e抗原（HBeAg）阳性的慢性肝炎状态转化为“非活性”或“携带者”状态（HBeAg阴性）历来被认为标志着HBV感染阶段或分期的变化，并导致更好的预后。自发性HBeAg血清转化的患者可减少肝纤维化，“无活性携带者状态”的患者预后较好，肝硬化和肝细胞癌（HCC）发生率较低。HBeAg血清转化与较好预后的关联可能是由于其与HBV病毒载量的降低有关，因为HBV DNA水平已被证明与HCC风险独立相关。与HBV单一感染相比，HIV-HBV合并感染增加了肝脏相关死亡的风险。然而，关于HIV-HBV合并感染的病毒学和血清学结果的信息很少。国家艾滋病毒指南建议开始艾滋病毒抗逆转录病毒治疗（ART），其中包括2种活性HBV药物，以防止对HBV产生耐药性。然而，一些专家认为，没有足够的数据来保证立即进行双重HBV治疗，如果单一治疗在48-96周后不能抑制HBV，则对第二种HBV药物进行排序是合理的。此外，有限的数据表明，HIV-HBV合并感染的人不太可能实现HBV病毒抑制，也不太可能失去HBeAg和产生抗hbe。艾滋病临床试验组（ACTG）纵向关联随机试验（ALLRT）研究是一项具有良好特征的4371名hiv感染者队列研究，这些患者被前瞻性地随机分配接受抗逆转录病毒治疗，并将样本存储在中央储存库中。因此，我们建议在这个理想的队列中确定那些有活动性HBV感染的受试者，并作为我们的主要目标，比较接受2种HBV活性药物的患者与接受1种HBV活性药物的患者在5年内的HBV病毒学抑制时间和HBeAg/anti- HBe状态的变化。我们还将评估丁型肝炎合并感染、基因型作为预后标志物，并对治疗中从未抑制或反弹HBV病毒血症的患者进行耐药性测试。进一步确定HIV-HBV合并感染的病程将有助于开展未来的发病机制研究和治疗介入试验。公共卫生相关性：乙型肝炎病毒（HBV）感染是人类免疫缺陷病毒（HIV）感染患者发病和死亡的重要原因。与仅含有一种抗HBV活性药物的HIV疗法相比，用于治疗HIV和HBV的联合疗法的有效性数据有限。该提案将通过测量参与前瞻性、纵向随机HIV临床试验的HIV-HBV合并感染患者的肝炎标志物和储存血液样本中的乙型肝炎病毒数量来检查HBV治疗的有效性。