Haydon Geoffrey H, Mutimer David J
Liver Unit, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK.
Curr Opin Infect Dis. 2003 Oct;16(5):473-9. doi: 10.1097/00001432-200310000-00015.
This review compares and contrasts the natural history and treatment of hepatitis B and C virus infections in three principal populations of immune compromised individuals: (1) patients co-infected with HIV; (2) patients with liver failure secondary to hepatitis B or C virus infection who undergo liver transplantation, and (3) patients with hepatitis B or C virus infection who undergo anticancer chemotherapy.
Chronic liver disease resulting from hepatitis B or C virus infection progresses more rapidly in patients co-infected with HIV than in HIV negative patients. Treatment protocols for antiviral therapy are, however, similar to those used in immunocompetent individuals and although few long-term results are available, the efficacy of interferon and ribavirin therapy in hepatitis C virus/HIV infection and lamivudine in HIV/hepatitis B virus infection has been proven in the short-term. Perhaps the most important consideration is the timing of administering treatments to co-infected patients. For patients with well preserved CD4 counts and hepatitis C virus/HIV co-infection, the hepatitis infection should be treated as early as possible to avoid drug interactions of hepatitis C virus antivirals with antiretroviral therapy. Also, response to hepatitis C virus treatment appears better when treatment is administered in the context of preserved immune function. Conversely, in hepatitis B virus/HIV co-infection, hepatitis B virus antivirals are best administered with anti-retroviral therapy, thus preventing the selection of HIV viral species which may be resistant to the drugs used for hepatitis B virus. Improved graft and patient survival after liver transplant and with anticancer chemotherapy in hepatitis B virus infected patients has been proven using lamivudine prophylaxis. However, although therapy for hepatitis C virus recurrence after liver transplantation would seem rational, limited success with current treatment protocols has been achieved.
Although the prognosis of hepatitis B and C virus infections in the immune compromised may be inferior to that of immunocompetent individuals, such patients should have full evaluation of their viral hepatitis, and antiviral therapy should be considered.
本综述比较并对比了免疫功能低下的三类主要人群中乙型和丙型肝炎病毒感染的自然史及治疗方法：（1）合并感染HIV的患者；（2）因乙型或丙型肝炎病毒感染继发肝衰竭而接受肝移植的患者；（3）接受抗癌化疗的乙型或丙型肝炎病毒感染患者。
与HIV阴性患者相比，合并感染HIV的患者中由乙型或丙型肝炎病毒感染导致的慢性肝病进展更快。然而，抗病毒治疗方案与免疫功能正常个体所使用的方案相似，尽管长期结果较少，但干扰素和利巴韦林治疗丙型肝炎病毒/HIV感染以及拉米夫定治疗HIV/乙型肝炎病毒感染的短期疗效已得到证实。或许最重要的考虑因素是对合并感染患者进行治疗的时机。对于CD⁺⁴细胞计数良好且合并丙型肝炎病毒/HIV感染的患者，应尽早治疗肝炎感染，以避免丙型肝炎病毒抗病毒药物与抗逆转录病毒疗法之间的药物相互作用。此外，在免疫功能保持的情况下进行丙型肝炎病毒治疗时，疗效似乎更好。相反，在乙型肝炎病毒/HIV合并感染中，乙型肝炎病毒抗病毒药物最好与抗逆转录病毒疗法联合使用，从而防止选择可能对用于治疗乙型肝炎病毒的药物耐药的HIV病毒株。已证实使用拉米夫定预防可提高乙型肝炎病毒感染患者肝移植及抗癌化疗后的移植物和患者生存率。然而，尽管肝移植后丙型肝炎病毒复发的治疗似乎合理，但目前的治疗方案取得的成功有限。
尽管免疫功能低下患者中乙型和丙型肝炎病毒感染的预后可能不如免疫功能正常个体，但此类患者应全面评估其病毒性肝炎情况，并应考虑进行抗病毒治疗。
