Resti Massimo, Azzari Chiara, Bortolotti Flavia
Department of Pediatrics, University of Florence, Florence, Italy.
Paediatr Drugs. 2002;4(9):571-80. doi: 10.2165/00128072-200204090-00003.
Mothers with hepatitis C virus (HCV) and HIV coinfection are the major source of HCV/HIV coinfection in infancy and childhood. There is no known intervention capable of interrupting HCV spread from mother to child, while the majority of infant HIV infections occurring in the developed world can be prevented by antiretroviral prophylaxis in the mother and child, elective caesarean section, and formula-feeding. In the era preceding treatment of HIV infection with highly active antiretroviral therapy, HCV coinfection was of little concern because the short-term survival of patients with HIV infection prevented the slowly developing consequences of chronic hepatitis C. As the life expectancy of patients with HIV infection increased with therapy, HCV has emerged as a significant pathogen. Several lines of evidence in adult patients suggest that liver disease may be more severe in patients coinfected with HIV and that progression of HIV disease may be accelerated by HCV coinfection. Whether coinfected children may share these clinical patterns remains a matter of speculation. Chronic hepatitis C in otherwise healthy children is usually a mild disease; liver damage may be sustained and fibrosis may increase over the years, suggesting slow progression of the disease. Interferon-alpha has been the only drug used in the past decade to treat hepatitis C in children and adolescents, with average response rates of 20%. Preliminary results of treatment with interferon-alpha and ribavirin suggest that the efficacy would be greater with combined therapy. These treatment protocols have not yet been applied to children coinfected with HIV, but the increasing number of long-term survivors will probably prompt further investigation in the near future. At present, treating HIV disease and monitoring HCV infection and hepatotoxicity induced by antiretroviral drugs seem to be the more reasonable approach to HCV/HIV coinfection in childhood.
丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）合并感染的母亲是婴幼儿期HCV/HIV合并感染的主要来源。目前尚无已知的干预措施能够阻断HCV从母亲传播给孩子，而在发达国家，大多数婴儿HIV感染可通过母婴抗逆转录病毒药物预防、选择性剖宫产和配方奶喂养来预防。在使用高效抗逆转录病毒疗法治疗HIV感染之前的时代，HCV合并感染并不受太多关注，因为HIV感染患者的短期生存状况使慢性丙型肝炎缓慢发展的后果未显现出来。随着HIV感染患者的预期寿命因治疗而延长，HCV已成为一种重要的病原体。成年患者的多项证据表明，HIV合并HCV感染的患者肝脏疾病可能更严重，并且HCV合并感染可能加速HIV疾病的进展。合并感染的儿童是否也有这些临床特征仍有待推测。在其他方面健康的儿童中，慢性丙型肝炎通常是一种轻度疾病；肝脏损害可能持续存在，纤维化可能会随着时间的推移而加重，提示疾病进展缓慢。在过去十年中，α干扰素一直是用于治疗儿童和青少年丙型肝炎的唯一药物，平均有效率为20%。α干扰素与利巴韦林联合治疗的初步结果表明，联合治疗疗效更佳。这些治疗方案尚未应用于合并HIV感染的儿童，但长期存活者数量的增加可能会促使在不久的将来进行进一步研究。目前，治疗HIV疾病并监测抗逆转录病毒药物引起的HCV感染和肝毒性，似乎是处理儿童HCV/HIV合并感染更为合理的方法。
