在成功的抗逆转录病毒治疗期间，HCV 核心的细胞免疫反应增加，HCV RNA 水平降低。

Cellular immune responses to HCV core increase and HCV RNA levels decrease during successful antiretroviral therapy.

机构信息

Klinik und Poliklinik für Infektiologie, University Hospital Berne and University of Berne, Inselspital PKT2B, 3010 Bern, Switzerland.

出版信息

Gut. 2010 Sep;59(9):1252-8. doi: 10.1136/gut.2009.205971. Epub 2010 Jul 26.

DOI:10.1136/gut.2009.205971

PMID:20660698

Abstract

BACKGROUND

Hepatitis C virus (HCV) infection is a major cause of morbidity in HIV infected individuals. Coinfection with HIV is associated with diminished HCV-specific immune responses and higher HCV RNA levels.

AIMS

To investigate whether long-term combination antiretroviral therapy (cART) restores HCV-specific T cell responses and improves the control of HCV replication.

METHODS

T cell responses were evaluated longitudinally in 80 HIV/HCV coinfected individuals by ex vivo interferon-gamma-ELISpot responses to HCV core peptides, that predominantly stimulate CD4(+) T cells. HCV RNA levels were assessed by real-time PCR in 114 individuals.

RESULTS

The proportion of individuals with detectable T cell responses to HCV core peptides was 19% before starting cART, 24% in the first year on cART and increased significantly to 45% and 49% after 33 and 70 months on cART (p=0.001). HCV-specific immune responses increased in individuals with chronic (+31%) and spontaneously cleared HCV infection (+30%). Median HCV RNA levels before starting cART were 6.5 log(10) IU/ml. During long-term cART, median HCV-RNA levels slightly decreased compared to pre-cART levels (-0.3 log10 IU/ml, p=0.02).

CONCLUSIONS

Successful cART is associated with increasing cellular immune responses to HCV core peptides and with a slight long-term decrease in HCV RNA levels. These findings are in line with the favourable clinical effects of cART on the natural history of hepatitis C and with the current recommendation to start cART earlier in HCV/HIV coinfected individuals.

摘要

背景

丙型肝炎病毒（HCV）感染是 HIV 感染者发病的主要原因。HIV 合并感染与 HCV 特异性免疫应答减弱和 HCV RNA 水平升高有关。

目的

研究长期联合抗逆转录病毒治疗（cART）是否恢复 HCV 特异性 T 细胞应答并改善 HCV 复制的控制。

方法

通过 HCV 核心肽的体外干扰素-γ-ELISpot 反应，对 80 例 HIV/HCV 合并感染患者进行了纵向 T 细胞应答评估，这些肽主要刺激 CD4+T 细胞。通过实时 PCR 评估了 114 例患者的 HCV RNA 水平。

结果

在开始 cART 之前，有检测到 HCV 核心肽 T 细胞应答的个体比例为 19%，在开始 cART 的第一年增加到 24%，在开始 cART 33 个月和 70 个月后分别显著增加到 45%和 49%（p=0.001）。慢性（+31%）和自发性清除 HCV 感染（+30%）患者的 HCV 特异性免疫应答增加。开始 cART 前的 HCV RNA 水平中位数为 6.5 log10 IU/ml。在长期 cART 期间，与 cART 前水平相比，HCV-RNA 水平中位数略有下降（-0.3 log10 IU/ml，p=0.02）。