Hughes Christine A, Shafran Stephen D
Faculty of Pharmacy and Pharmaceutical Sciences, HIV, Capital Health Region, Edmonton, Alberta, Canada.
Ann Pharmacother. 2006 Mar;40(3):479-89; quiz 582-3. doi: 10.1345/aph.1G427. Epub 2006 Feb 28.
To review the current management of hepatitis C virus (HCV) in persons coinfected with HIV.
A MEDLINE search (1966-February 2006) was conducted, using key words such as HIV, human immunodeficiency virus, hepatitis C, interferon, pegylated interferon, and therapy. Article bibliographies and conference abstracts were also reviewed to identify relevant studies.
Studies that examined HCV treatment in individuals coinfected with HIV and articles that focused on HCV/HIV coinfection were considered for this review.
Coinfection with HIV leads to a more rapid and severe course of HCV-related liver disease. Treatment of HCV with pegylated interferon (PEG-IFN) and ribavirin therapy is relatively well tolerated in individuals coinfected with HIV, with overall sustained virologic response (SVR) rates of 27-40%. High relapse rates and poor response in HCV-genotype 1 contribute to the lower SVR in coinfected individuals compared with HCV monoinfection. Treatment of HCV is more complicated in HIV-infected persons due to increased risk of myelosuppression, drug interactions, hepatotoxicity of antiretroviral therapy, and the relative contraindication to interferon therapy in advanced HIV disease. Current guidelines recommend that all HIV-positive patients with chronic HCV infection be considered as treatment candidates for anti-HCV therapy due to the higher risk of liver disease progression. Further studies are needed, however, to define the appropriate dose and duration of therapy in HCV/HIV-coinfected individuals.
Response to treatment with PEG-IFN and ribavirin is poorer in patients coinfected with HCV/HIV than in those infected with HCV alone. The benefits of anti-HCV therapy, including viral eradication, need to be weighed against the risks of adverse effects and drug-drug interactions between anti-HCV and antiretroviral medications.
综述目前对合并感染人类免疫缺陷病毒（HIV）的丙型肝炎病毒（HCV）感染者的管理。
利用诸如HIV、人类免疫缺陷病毒、丙型肝炎、干扰素、聚乙二醇化干扰素及治疗等关键词，进行了MEDLINE检索（1966年至2006年2月）。还查阅了文章的参考文献及会议摘要以确定相关研究。
本综述纳入了检测合并感染HIV个体的HCV治疗情况的研究以及关注HCV/HIV合并感染的文章。
合并感染HIV会导致HCV相关肝病的病程进展更快且病情更严重。在合并感染HIV的个体中，聚乙二醇化干扰素（PEG-IFN）联合利巴韦林治疗HCV的耐受性相对较好，总体持续病毒学应答（SVR）率为27%至40%。与单纯HCV感染相比，HCV基因1型的高复发率及低应答率导致合并感染个体的SVR较低。由于骨髓抑制风险增加、药物相互作用、抗逆转录病毒治疗的肝毒性以及晚期HIV疾病中干扰素治疗的相对禁忌证，在HIV感染者中治疗HCV更为复杂。目前的指南建议，所有慢性HCV感染的HIV阳性患者均应被视为抗HCV治疗的候选者，因为其肝病进展风险较高。然而，需要进一步研究以确定HCV/HIV合并感染个体的适当治疗剂量和疗程。
HCV/HIV合并感染患者对PEG-IFN联合利巴韦林治疗的应答比单纯HCV感染患者差。抗HCV治疗的益处，包括病毒根除，需要与不良反应风险以及抗HCV药物和抗逆转录病毒药物之间的药物相互作用风险相权衡。
