hepatitis B virus B 15% 25 HBsAg B HBV HBsAg 15% 20% HBV HBV 90% 16 HIV HBV

Transcription

1 hepatitis virus HV 20 15% HV HsAg HV 15% 20% HV HsAg HV HV HV 90% 16 5% HV

2 HV CD8 73% 98% HV 90% HV HsAg 6 10% HsAg 0.5% 1% HV HV HV HV HCV TNF- TNF- T [1] HV X-protein HV HV HV 6 8 AIDS HV 11

3 HV HV HV [5] Colin [2] [4] HV 65 HV ALT HV DNA HV [3] HV Hs HV Hs HsAg HV HV DNA [5,6] Hs HV HV AIDS HV HV HV [7] HeAg HV

4 HV 14.2/1,000 HV HCV 0.8/1,000 CD8 T 12.3/1, /1,000 [6] IRS 4 HV 1 HV HCV [2] HV HV [8] 5 HV cytochrome p450 HV 2 HV HV HV T 3 immune reconstitution syndrome TNF- TNF- 13

5 [9] HV Hs X-protein LTR HV HV Hs HV <1% HsAg HV HV HV HsAg HV iso- HV Hs lated Hc HV HsAg HV HV Hs HV HsAg Hc 1 Hs Hc 2 HV HV HV Hs HV 3 HsAg [10] HV DNA occult HV infection HV

6 Hc 2% 5% 25.4% Hc 42% 81% [11,12] Hc HCV 4.9 HV [13,14] HV Hc [11] Hs 45.3% HV Hs Hc 18.6% Hs HV [12] HV HV Piroth [13] HsAg Hs Hc 86% Hc 28.3% 16% 2.2 HsAg Rodriguez [14] % Hs Hc Hc 15

7 HsAg Hs low HsAg 300 mg HV 1 level HeAg 22% 29% [15,16] Hc 7.3% HV DNA <400 copies/ml 40% 87% HV DNA HV DNA enhamou [17] 10 3 copies/ml 12 HsAg HV 12 Hs 6 HV DNA 86% HV 96% HV DNA Hc % Hs 45.3% Hc ALT 44 IU/L p= % HV DNA 27 5 HeAg 3 Hs He HsAg Hs HV Hs HV HV YMDD Lamivudine Lamivudine 1 25% 2 HV 50% 4 90% [15,17]

8 HV DNA HV DNA Adefovir HV 10 mg/day 3.0 log [21] HV HV YMDD HeAg 1 HeAg HeAg Adefovir 30% HV DNA HeAg 82% HV HV/ 48 25% DNA 1 HV DNA HeAg [22] 10% 3 adefovir adefovir [18] adefovir cross-resistance Tenofovir Entecavir HV 0.5 mg HV YMDD HV adefovir HV 1.0 mg [23] HV [19] 52 YMDD HV/ adefovir adefovir HV DNA 4.44 log 3.21 log entecavir 1.0 mg 6 HV DNA 3.66 log copies/ml 1 84% HV DNA < 400 copies/ml [23] [20] HV [24] HV adefovir HV DNA 4.7 log 17

9 emtricitabine HV 24 HV HV HsAg HV HV [25] HV HV 85% 90% Hs HV Hs

10 30% [10] 20 43% vs. 7%, p=0.035 Hc HV [10] HV Hs 350 cells/ L Hc 90% 69 HsAg HV HV Hs 29 42% Hc HV 40 58% recombinant 4 Hc HV HsAg 24% Hs HV 10% p=0.18 Hc He 4 Hs Hc He 19

11 Hs HV 3 5 HV % HV HCV HDV HV HV HsAg Hs Hc 28% Hc HV HV HV 23% < > 1.Gomez-Gonzalo M, Carrerero M, Rullas J, et al. The hepatitis virus X protein induces -1 replication and transcription in synergy with T-cell activation signals. J iol Chem 2001;276: Sulkowski MS, Thomas DL, Chaisson RE, et al. Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis C or virus infection. JAMA 2000;283: Hadler SC, Judson FN, O'Malley PM, et al. Outcome of hepatitis virus infection in homosexual men and its relation to prior human immunodeficiency virus infection. J Infect Dis 1991;163: Colin JF, Cazals-Hatem D, Loriot MA, et al. Influence of human immunodeficiency

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13 48-week study of or or a combination of and for the treatment of chronic hepatitis in /HV co-infected individuals [abstract 831]. In: Program and abstracts of the 13th Conference on Retroviruses and Opportunistic Infections (Denver). Alexandria, VA: Foundation for Retrovirology and Human Health, Peters M, Anderson J, Lynch P, et al. Tenofovir disoproxil fumarate is not inferior to adefovir dipivoxil for the treatment of hepatitis virus in subjects who are co-infected with : results of ACTG A5127 [abstract 124]. In: Program and abstracts of the 12th Conference on Retroviruses and Opportunistic Infections (oston). Alexandria, VA: Foundation for Retrovirology and Human Health, Dore G, Cooper D, Pozniak A, et al. Efficacy of disoproxil fumarate in antiretroviral therapy naive and - experienced patients coinfected with -1 and hepatitis virus. J Infect Dis 2004;189: Pessoa W, Gazzard, Huang A, et al. Entecavir efficacy in /HV co-infected patients: safety and efficacy in a phase II study (ETV-038) [oral abstract 123]. In: Program and abstracts of the 12th Conference on Retroviruses and Opportunistic Infections (oston). Alexandria, VA: Foundation for Retrovirology and Human Health, Anonymous. Guidelines for the use of antiretroviral agents in -1-infected adults and adolescents. U.S. Department of Health and Human Services ( DHHS). October 10, ( AIDSinfo.nih.gov.) 25.Chang MH, Chen PJ, Lai MS, et al. Universal hepatitis vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. N Engl J Med 1997;336: