HIV合并肝病诊治思路.ppt

核苷类似物对HBV和HIV都有抑制作用，因此不建议单独用于HBV的治疗！CHB患者使用核苷类药物前应该排除HIV感染。更改HAART药物组合时要兼顾HBV的治疗。3TC、FTC、TDF等撤除时可能会发生肝炎活动。HIV/HBV感染者ART要考虑的问题*各国指南对HIV/HBV合并感染者推荐的ART方案指南HAART方案中国艾滋病诊疗指南修改版1建议ART治疗方案中含有TDF+3TC中国艾滋病免费治疗指南2TDF+3TC+EFVWHO成人与青少年HIV患者抗逆转录病毒治疗指南3建议治疗方案中含有TDF+3TC或TDF+FTC美国DHHS成人与青少年HIV-1感染患者抗逆转录病毒治疗指南4建议治疗方案中含有TDF+3TC或TDF+FTC艾滋病诊疗指南（修改版）HIV/AIDS国家免费诊疗指南手册WorldHealthOrganization.AntiretroviraltherapyforHIVinfectioninadultsandadolescents.Recommendationsforapublichealthapproach.2010revision.DevelopedbytheDHHSPanelonantiretroviralguidelinesforadultsandadolescents-AworkinggroupoftheofficeofAIDSresearchadvisorycouncil(OARAC).GuidelinesfortheuseofantiretroviralagentsinHIV-1-infectedadultsandadolescents.January10,2011.HIV/HCV合并感染抗HCV治疗

HAART方案国家免费艾滋病抗病毒药物治疗手册2016使用NNRTI患者122122122111866337217肝脏毒性增长百分比(%)6.54.14.12.71.21.62.700长期使用NNRTIs的肝毒性在单因素分析中，只有合并HCV感染与NNRTI组中出现肝毒性反应有关[优势比(OR)为1.83%；95%置信区间(CI)为1.33-4.24；P0.01]。合并感染的患者中50%出现肝毒性反应，而无HCV感染患者的发生率仅为12.3%(P0.01)BJVanWelzen,etal.HIVMedicin.2012,13,448-452无肝毒性生存率治疗时间(年)*Slide#13:HIVCoinfectionIncreasestheRiskofESLDDuetoHBVThioandcolleaguesexaminedliver-relatedmortalityamongpeopleatriskforHIV-1andHBVinfectionsusingdatafromtheMulticenterCohortStudy.Ofthe4967HBsAGnegativemenwhohavesexwithmen,47%(n=2346)wereHIVpositive.Ofthe326HBsAGpositive,65%(n=213)werealsoinfectedwithHIV.HIV/HBVcoinfectionledtoa19-foldhigherriskofliverdeathcomparedwithHBVmonoinfection.Theriskofliver-relatedmortalityincreasedwith:Alcoholconsumption.LownadirCD4cellcounts.Antiretroviraltherapy.ReferenceThioCL,SeabergEC,SkolaskyRJr,etal.HIV-1,hepatitisBvirus,andriskofliver-relatedmortalityintheMulticenterCohortStudy(MACS).Lancet.2002;360:1921-1926.*****EuropeanAIDSClinicalSociety(EACS)guidelines*HIV合并肝病诊治思路HIV