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

HIV和B型肝炎（HBV）合并感染很常见，并显著增加肝脏疾病的进展 与死艾滋病毒/乙型肝炎病毒合并感染的风险人群包括非洲和亚洲的人群，这些地区的艾滋病毒/乙型肝炎病毒合并感染的风险很高。 在HBV高流行的情况下继续传播。拉米夫定（3 TC），一种抗逆转录病毒药物（ARV） 有效对抗HBV，包括在4种WHO一线ARV治疗方案中，但关于HIV/HBV的数据很少 这些领域的治疗效果。有证据表明，HBV基因型可预测对 疗法同样，HBV和HBV病毒载量、基因型和耐药性等因素可能有助于 非洲ARV治疗期间的肝毒性，但对HBV在HIV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相一致，其共同 感染，以及在资源有限的情况下的治疗策略，本研究的目的是1）表征 HBV感染的流行率和HIV感染的基因型2）研究HBV基因型在 HBV抑制和耐药形成; 3）检查HBV感染与重度 南非艾滋病毒感染者抗逆转录病毒药物的肝毒性。主要目的是支持申请人的病人- 通过指导、分子流行病学培训和 获得公共卫生硕士学位。拟议的研究是一项前瞻性队列研究， 在开普敦艾滋病队列中，一项由美国国立卫生研究院资助的南非艾滋病治疗研究。该人群 将以HIV/HBV合并感染和HBV基因型为特征。HBV抑制和耐药性将 135例HIV/HBV合并感染者接受含3 TC的ARV治疗后1年时确定。中 估计有135例肝毒性，HBV感染和病毒学因素的存在将与 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， 肝毒性将纳入HBV对治疗结局影响的统计模型中。长期 本研究的目的是确定HIV/HBV合并感染治疗结果的预测因子。本研究 第一个在资源有限的情况下研究HBV基因型在HIV/HBV治疗结果中的作用。如果 HBV病毒学因素与HIV/HBV合并感染的治疗结果相关， 这些因素可能会改善HIV/HBV合并感染的未来诊断和治疗策略。

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.