Verma Sumita
Division of Gastroenterology and Hepatology, Johns Hopkins University Hospital, Baltimore, MD 21205, USA.
J Antimicrob Chemother. 2006 Sep;58(3):496-501. doi: 10.1093/jac/dkl280. Epub 2006 Jul 19.
Since highly active antiretroviral therapy (HAART) has significantly improved survival in patients with HIV, liver disease from hepatitis C virus (HCV) infection is now an important cause of morbidity and mortality in such a cohort. Studies assessing liver fibrosis in an HIV/HCV cohort are beset with methodological flaws and heterogeneity of the study population, precluding definite conclusions. Nonetheless, recent data (albeit from retrospective studies) do suggest that HAART can attenuate liver fibrosis in the co-infected cohort with fibrosis progression rates comparable to the mono-infected patients. This is especially true for those patients whose HIV was diagnosed after 1996 and for whom HAART is associated with successful viral suppression. The mechanism/s underlying this favourable course of events however remain speculative but could be related to immune restoration-induced changes in inflammatory and fibrogenic cytokines or to a direct effect of HAART on hepatic fibrosis. Therefore with the current available evidence it seems unjustifiable to defer HAART in those that need it because of concerns regarding potential hepatotoxicity as the benefits (both from the HIV and HCV viewpoint) probably outweigh any potential risks. Nonetheless, this issue can only be unequivocally resolved by better designed prospective studies.
由于高效抗逆转录病毒疗法（HAART）显著提高了HIV患者的生存率，丙型肝炎病毒（HCV）感染所致的肝脏疾病现已成为该群体发病和死亡的重要原因。评估HIV/HCV群体肝纤维化的研究存在方法学缺陷和研究人群的异质性，无法得出明确结论。尽管如此，最近的数据（尽管来自回顾性研究）确实表明，HAART可以减轻合并感染群体的肝纤维化，其纤维化进展率与单一感染患者相当。对于那些1996年后被诊断出HIV且HAART与病毒成功抑制相关的患者尤其如此。然而，这一有利事件背后的机制仍具有推测性，但可能与免疫恢复引起的炎症和纤维化细胞因子变化有关，或者与HAART对肝纤维化的直接作用有关。因此，根据目前可得的证据，因担心潜在肝毒性而推迟对有需要者进行HAART似乎不合理，因为（从HIV和HCV的角度来看）益处可能超过任何潜在风险。尽管如此，这个问题只有通过设计更好的前瞻性研究才能明确解决。
