Cytokines and chemokines involved in hepatitis B surface antigen loss in human immunodeficiency virus/hepatitis B virus coinfected patients

概要

It is estimated that there are approximately 39.0 million people living with human immunodeficiency virus (HIV) and 30 thousand of them were living in Japan at the end of 2019. Approximately 7.4% of the HIV-infected population worldwide, and 5–8% of population in Japan, are infected with hepatitis B virus (HBV). It has been reported that hepatic flare (HF), attributable to the development of immune reconstitution inflammatory syndrome (IRIS) in HIV/HBV coinfected patients, occurs frequently after the start of anti-retroviral therapy (ART). We have observed several cases of hepatitis B surface antigen (HBsAg) loss after IRIS. However, the factors leading to HBsAg clearance remain unknown. We measured CD4+ and CD8+ T cells, cytokines and chemokines in 16 patients coinfected HIV-1 and HBV with IRIS, and analyzed the factors leading to HBsAg clearance after IRIS. There was no significant difference in the CD4+ and CD8+ T cell counts between the HBsAg clearance and non-clearance groups, while the serum concentrations of almost all cytokines and chemokines in the HBsAg clearance group were higher than in the HBsAg non-clearance group at any time of observation. In particular, IP-10 at the ALT peak, GM-CSF and IL-12 one month after the ALT peak and TNF-_ and GM-CSF after the ALT concentrations fell to within normal limits, were significantly higher in the HBsAg clearance group.
It seems that HBsAg loss after IRIS requires continued immune responses against HBV, involving Th1 cytokines.