The treatment dynamics assessment among patients with chronic viral hepatitis B, infected with human immunodeficiency virus
KeywordsCHB/HIV coinfection, quantitative determination of HBsAg (qHBsAg), HBV DNA, CD4 , ΔCD4 , “ALT flare”, hardly active antiretroviral therapy (HAART)
Introduction: the article represents prospective study results of the treatment dynamics among patients with chronic viral hepatitis B, infected with human immunodeficiency virus. Particularly, the role of qHBsAg dynamics in the serum concerning CHB treatment effectiveness of CHB/HIV coinfected patients as well as clinical and laboratory factors influencing on this marker.
The study purpose: To assess treatment dynamics of CHB/HIV coinfected patients basing on quantitative HBsAg determination and other clinical and laboratory test applying.
Material and methods: 60 coinfected patients were examined – the main group, 60 CHB monoinfected patients – comparison group to reach established study purpose. Diagnosis of HIV and chronic hepatitis B were verified. A clinical, laboratory, serological, molecular-genetic methods were used. Statistical processing of results was held with applying parametric and nonparametric methods for the data analysis.
Research results: There was a slight increase by 1.10 times in serum ALT in “a period of ≤ 6 months of antiviral therapy” with a subsequent decrease by 1.20-1.46 times in “a period of ˃ 6 months of therapy”. There was a decrease in the serum qHBsAg of coinfected patients in accordance with the duration of therapy by 1.56-21.10 times, and in case of the presence of "ALT flare" by 1.31-72.72 times. The greatest decrease in serum qHBsAg by 1.63-42.00 times during HAART was also observed in patients with an initial CD4 + count <350 cells / μl. A serum qHBsAg was 11.24 times lower after ˃ 12 months of therapy in the group of CHB/HIV coinfected patients with ΔCD4 + ˃100 cells / μl compared with the group of patients with ΔCD4 + 0 - 100 cells / μl.
Conclusions: A serum qHBsAg possibly to be decreased by 2 log10 among CHB/HIV coinfected patients after starting HAART with dual activity against HBV and HIV which includes nucleoside reverse transcriptase analogs (Tenofovir Disoproxil Fumarate (TDF) and lamivudine (3TC)). Defined main influencing factors on qHBsAg decreasing included: “ALT flare”, CD4+ count, ΔCD4+ as a result of monofactorial analysis. It is necessary to conduct further multifactorial analysis to determine complex of factors which could influence on further HBsAg by 2 log10 and HBsAg clearance.
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