Department of Internal Medicine I, Bonn university, Bonn, Germany.
Eur J Med Res. 2009;14(12):507-15. doi: 10.1186/2047-783x-14-12-507.
Chronic HCV co-infection is present in up to one third of HIV-positive patients in Europe. In recent years, apart from the traditional transmission route of intravenous drug abuse, outbreaks of sexually transmitted acute HCV infections, mainly among HIV-positive men who have sex with men, have contributed to the overall disease burden. - Because the natural course of HCV infection is substantially accelerated in HIV-co-infection, end-stage liver disease has become the most frequent cause of non-AIDS related death in this population. Therefore every HIV/HCV co-infected patient should be evaluated for possible anti-HCV therapy with the goal of reaching a sustained virological response and thus cure of hepatitis C infection. The standard of care for the treatment of chronic HCV infection in HIV-infected remains a pegylated interferon in combination with weight-adapted ribavirin. - HAART should not be withheld from HCV co-infected patients due to concerns of drug related hepatotoxicity and in patients with reduced CD4-cell counts HAART should be started first. Under pegylated interferon and ribavirin combination therapy drug to drug interactions and cumulated toxicity between nucleoside analogues and anti-HCV therapy may be observed and concomitant didanosine use is contraindicated and zidovudine and stavudine should be avoided if possible. - The development of new drugs for the treatment of chronic hepatitis C represents a promising perspective also for HIV positive patients. However, these substances will probably reach clinical routine for HIV patients later than HCV monoinfected patients. Therefore at present waiting for new drugs is not an alternative to a modern pegylated interferon/ribavirin therapy.
慢性 HCV 合并感染在欧洲高达三分之一的 HIV 阳性患者中存在。近年来，除了静脉药物滥用这一传统传播途径外，性传播的急性 HCV 感染爆发，主要发生在 HIV 阳性的男男性行为者中，也导致了整体疾病负担的增加。由于 HCV 感染在 HIV 合并感染中的自然病程大大加速，终末期肝病已成为该人群中与艾滋病无关的死亡的最常见原因。因此，每一位 HIV/HCV 合并感染的患者都应评估是否可能进行抗 HCV 治疗，目标是实现持续病毒学应答，从而治愈丙型肝炎感染。在 HIV 感染者中治疗慢性 HCV 感染的标准护理仍然是聚乙二醇干扰素联合体重适应性利巴韦林。不应该因为担心药物相关肝毒性而对 HCV 合并感染的患者延迟使用抗逆转录病毒治疗，对于 CD4 细胞计数减少的患者，应首先开始抗逆转录病毒治疗。在聚乙二醇干扰素和利巴韦林联合治疗中，可能会观察到药物相互作用和核苷类似物与抗 HCV 治疗之间的累积毒性，同时禁忌使用叠氮胸苷，并且如果可能，应避免使用齐多夫定和司他夫定。治疗慢性丙型肝炎的新药的开发也为 HIV 阳性患者带来了有希望的前景。然而，这些药物可能会比 HCV 单感染患者更晚应用于 HIV 患者。因此，目前等待新药并不是替代现代聚乙二醇干扰素/利巴韦林治疗的选择。
