HIV and Hepatitis B Coinfection: Hepatitis B Genotype, Resistance and Outcomes

艾滋病毒和乙肝病毒(乙肝)混合感染很常见，并显著增加了肝脏疾病的进展 和死亡。艾滋病毒/乙肝病毒混合感染的风险人群包括非洲和亚洲的人群，这两个地区的艾滋病毒 在乙肝病毒高度流行的背景下继续传播。抗逆转录病毒(ARV)拉米夫定(3TC) 有效对抗乙肝病毒，包括在世卫组织的4种一线抗逆转录病毒疗法中，但关于艾滋病毒/乙肝病毒的数据很少 这些领域的治疗结果。有证据表明，乙肝病毒的基因型别可以预测对 心理治疗。同样，乙肝病毒和诸如乙肝病毒载量、基因型别和耐药性等因素也可能导致 非洲抗逆转录病毒治疗中的肝脏毒性，但对乙肝病毒在艾滋病毒治疗中的作用知之甚少 结果。与NIAID促进艾滋病毒国际合作研究的目标一致，其共同 在资源有限的情况下，感染和治疗策略，这项研究的目的是1)特征 HIV感染中乙肝病毒感染的流行情况及基因分型2)检测乙肝病毒基因分型在艾滋病中的作用 乙肝病毒抑制和耐药性的形成；3)研究乙肝病毒感染与重型肝炎的关系 南非使用抗逆转录病毒药物的HIV患者的肝毒性。主要目的是支持申请人的病人- 通过指导、分子流行病学方面的培训和 获得公共卫生硕士学位。建议的研究是嵌套的前瞻性队列研究。 在开普敦艾滋病队列中，NIH资助了一项关于南非艾滋病毒治疗的研究。这群人 将以艾滋病毒/乙肝病毒混合感染和乙肝病毒基因型别为特征。那么乙肝病毒的抑制和抗药性就会 在135例接受含ARV的3TC治疗的HIV/HBV混合感染者中，在1年后被检测到。在一个 估计135名有肝毒性的人，是否存在乙肝病毒感染和病毒学因素将与 1215控制。潜在的混杂因素，如丙型肝炎、肝病、ARV方案和其他原因 肝毒性将被包括在乙肝病毒对治疗结果影响的统计模型中。长期的 这项研究的目标是确定艾滋病毒/乙肝病毒混合感染的治疗结果的预测因素。这项研究是 第一次在资源有限的情况下研究了乙肝病毒基因型在艾滋病毒/乙肝治疗结果中的作用。如果 乙肝病毒病毒学因素与艾滋病毒/乙肝病毒混合感染的治疗结果相关，然后确定 这些因素可能会改进未来艾滋病毒/乙肝病毒混合感染的诊断和治疗策略。

HIV and hepatitis B (HBV) co-infection is common and significantly increases the progression to liver disease and death. Populations at risk for HIV/HBV co-infection include those in Africa and Asia, regions where HIV continues to spread in the setting of HBV hyperendemicity. Lamivudine (3TC), an antiretroviral (ARV) effective against HBV, is included in 4 WHO first-line ARV regimens, yet there is little data on HIV/HBV treatment outcomes in these areas. Evidence suggests that HBV genotype is predictive of response to therapy. Likewise, HBV and factors such as HBV viral load, genotype, and resistance may contribute to hepatotoxicity during ARV therapy in Africa, and yet little is known about the role of HBV in HIV treatment outcomes. Consistent with the NIAID's goal to foster international collaborative research on HIV,its co- infections, and therapeutic strategies in resource limited settings, the aims of this study are 1) to characterize the prevalence of HBV infection and genotypes in HIV infection 2) to examine the role of HBV genotype in HBV suppression and resistance formation and 3) to examine the association of HBV infection to severe hepatotoxicity in HIV individuals on ARVs in South Africa. A primary aim is to support the applicant's patient- oriented research career development through mentoring, training in molecular epidemiology, and the receipt of a Master's Degree in Public Health. The proposed research is a prospective cohort study nested within the Cape Town AIDS Cohort, an NIH funded study of HIV treatment in South Africa. This population will be characterized for HIV/HBV coinfection and HBV genotype. HBV suppression and resistance will then be determined at 1 year in 135 HIV/HBV coinfected individuals receiving 3TC containing ARV therapy. In an estimated 135 with hepatotoxicity, the presence of HBV infection and virologic factors will be compared to 1215 controls. Potential confounders such as hepatitis C, liver disease, ARV regimen, and other causes of hepatotoxicity will be included in the statistical models of HBV effect on treatment outcomes. The long-term goals of this research are to identify predictors of therapeutic outcomes in HIV/HBV coinfection. This study is the first to examine the role of HBV genotype in HIV/HBV treatment outcomes in a resource limited setting. If HBV virologic factors are associated with treatment outcomes in HIV/HBV coinfection, then identifying such factors may improve future diagnostic and therapeutic strategies in HIV/HBV co-infection.