Zoller Heinz, Vogel Wolfgang
Innsbruck Medical University, University Hospital of Innsbruck, Department of Medicine, Clinical Division of Gastroenterology and Hepatology, Anichstrasse 35, Austria.
Int J Nanomedicine. 2006;1(4):399-409. doi: 10.2147/nano.2006.1.4.399.
In immuno-competent individuals, the natural course of chronic hepatitis C virus (HCV) infection is highly variable and 5%-30% of patients develop cirrhosis over 20 years. Co-infection with HCV and human immunodeficiency virus (HIV) is an important prognostic factor and associated with more frequent and accelerated progression to cirrhosis. Until recently HIV/AIDS-related complications were life limiting in patients co-infected with HCV; the introduction of highly active antiretroviral treatment (HAART) and the better prognosis of HIV infection has made HCV-related complications an emerging health problem in HCV/HIV coinfected individuals. Treatment of chronic HCV infection has also evolved since the introduction of interferon-alpha. Recently, introduction of pegylated interferon-alpha (peginterferon-alpha) has resulted in an increase in sustained virus clearance rates of up to 80% in selected genotypes and patient populations. The safety and efficacy of modern anti HCV treatment regimens - based on peginterferon-alpha in combination with ribavirin - was evaluated in 4 controlled trials. Sustained clearance of hepatitis C virus can be achieved in up to 35% of patients with HIV/HCV co-infection, and novel HCV treatment regimens based on peginterferon-alpha have no negative effect on the control of HIV disease. In conclusion, if HIV infection is well controlled and CD4+ cell counts >100/mm3, treatment of chronic hepatitis C with peginterferon in combination with ribavirin is safe and should be given for 48 weeks regardless of the HCV genotype. Introduction of peginterferon-alpha has significantly improved adherence to treatment and treatment efficacy; in particular sustained virologic response in patients with HCV genotype 1 or 4 infection improved, but sustained viral clearance in only 7%-38% of patients infected with genotype I and 4 cannot be the final step in development of effective treatments in patients with HCV/HIV co-infection.
在免疫功能正常的个体中，慢性丙型肝炎病毒（HCV）感染的自然病程差异很大，5%至30%的患者在20年内会发展为肝硬化。HCV与人类免疫缺陷病毒（HIV）合并感染是一个重要的预后因素，与更频繁和加速发展为肝硬化相关。直到最近，HIV/AIDS相关并发症在HCV合并感染患者中仍限制着生命；高效抗逆转录病毒治疗（HAART）的引入以及HIV感染预后的改善，使得HCV相关并发症成为HCV/HIV合并感染个体中一个新出现的健康问题。自干扰素-α问世以来，慢性HCV感染的治疗也有了进展。最近，聚乙二醇化干扰素-α（peginterferon-alpha）的引入使特定基因型和患者群体的持续病毒清除率提高到了80%。在4项对照试验中评估了基于peginterferon-alpha联合利巴韦林的现代抗HCV治疗方案的安全性和有效性。在高达35%的HIV/HCV合并感染患者中可实现HCV的持续清除，基于peginterferon-alpha的新型HCV治疗方案对HIV疾病的控制没有负面影响。总之，如果HIV感染得到良好控制且CD4+细胞计数>100/mm3，用peginterferon联合利巴韦林治疗慢性丙型肝炎是安全的，无论HCV基因型如何，均应给予48周的治疗。peginterferon-alpha的引入显著提高了治疗依从性和治疗效果；特别是HCV基因型1或4感染患者的持续病毒学应答有所改善，但仅7%至38%的基因型1和4感染患者实现持续病毒清除，这不可能是HCV/HIV合并感染患者有效治疗发展的最后一步。
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