在曾单独应用和未曾应用拉米夫定的患者中，研究联合应用抗病毒药物替诺福韦+恩曲他滨或应用替诺福韦+拉米夫定的治疗效果。我们选取31名HIV/HBV联合感染的患者，其中12名患者未曾应用拉米夫定治疗，首次应用替诺福韦+恩曲他滨治疗；19名患者曾经应用拉米夫定治疗效果不佳，给予替诺福韦+恩曲他滨治疗。未曾应用拉米夫定治疗组和曾应用拉米夫定治疗组HBV DNA 平均基线水平相近，分别为5.8×10^7拷贝/mL和7.3×10^7拷贝/mL。两组完全抑制HBV的平均时间分别为466天和877天。12个月后，60%初治患者和21%曾经应用拉米夫定治疗的患者，他们的HBV 病毒量降至检测下限值。24个月后，全部初治患者和31%曾经应用拉米夫定治疗患者的HBV病毒定量检测不到。在初治患者中，抑制HBV DNA的平均时间明显缩短。在治疗24个月时，初治患者中有相当高比例的患者产生HBV病毒抑制。研究结果推荐在HIV/HBV联合感染的患者中，首次治疗即开始应用双药的治疗方案。




Goal：To study the effect of combination antiviral therapy with tenofovir and emtricitabine or lamivudine with and without prior monotherapy with lamivudine.Study：We reviewed charts of 31 HIV-/HBV-coinfected patients. Twelve 3TC-naive patients initially received tenofovir plus emtricitabine. Nineteen epivir experienced patients who had previously failed epivir were given tenofovir plus emtricitabine. Results：Baseline median HBV DNA was similar in the epivir-naive (5.8×10^7copies/mL) and experienced group (7.3×10^7copies/mL, P = .65). The median time to complete suppression of HBV was 466 days in the naive group and 877 days in the experienced (P = .001).After 12 months, 6/10 (60%) naive patients and 3/14 (21%) experienced patients had HBV DNA below the detection-limit (P = .067). After 24 months, 5/5 (100%) naive patients and 4/13 (31%) experienced patients had an undetectable HBV DNA level (P = .015).Conclusions：The median time to suppression of HBV DNA was signifi-cantly shorter among treatment naive patients. There was a significantly greater proportion of naive patients with suppressed HBV DNA at 24 months. Our results support using initial dual therapy in those with HIV/HBV coinfection.