Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Waehringer Guertel 18-20, A1090 Vienna, Austria.
J Clin Virol. 2010 Oct;49(2):131-3. doi: 10.1016/j.jcv.2010.07.006. Epub 2010 Aug 14.
The efficacy of antiviral therapy with pegylated interferon (PEGIFN) plus ribavirin (RBV) in patients with HIV and hepatitis C virus (HCV) coinfection is limited. Intravenous silibinin (ivSIL), a milk thistle extract with proven antiviral effects represents a novel therapeutic strategy for virological nonresponders.
We report a case of an HIV-HCV coinfected patient, who has not responded to a prior course of PEGIFN-α2a (180 μg/week/s.c.) and RBV (1000 mg/day/p.o.). Testing for IL-28β small nucleotid polymorphism revealed the nonfavourable genotype T/T. Antiretroviral therapy was not prescribed because the patients presented with well-preserved CD4+ cell counts and low HIV-RNA levels. She received retreatment with ivSIL for two weeks followed by PEGIFN/RBV combination therapy starting at week 1.
After 2 weeks of ivSIL therapy both HCV-RNA and HIV-RNA become undetectable. On ivSIL monotherapy we noticed a trend towards an increase of CD4+ cell counts and a decrease of HIV-RNA. After 16 weeks PEGIFN+RBV was discontinued due to patients wish because of adverse events. HCV-RNA was still negative 24 weeks after cessation of therapy, while HIV-RNA returned to baseline levels.
ivSIL may represent a potential treatment option for retreatment of HIV-HCV coinfected patients nonresponding to PEGIFN+RBV combination therapy. Further investigations on the possible beneficial effects of ivSIL on CD4+ cell counts and HIV-RNA levels are necessary.
聚乙二醇干扰素（PEGIFN）联合利巴韦林（RBV）治疗 HIV 和丙型肝炎病毒（HCV）合并感染患者的疗效有限。水飞蓟宾（ivSIL）是一种具有明确抗病毒作用的奶蓟提取物，为病毒学无应答者提供了一种新的治疗策略。
我们报告了一例 HIV-HCV 合并感染患者，该患者对先前的 PEGIFN-α2a（180μg/周/皮下注射）和 RBV（1000mg/天/口服）治疗无反应。检测 IL-28β 小核苷酸多态性显示非有利基因型 T/T。未开具抗逆转录病毒治疗药物，因为患者的 CD4+细胞计数保持良好，HIV-RNA 水平较低。她接受了两周的 ivSIL 治疗，然后在第 1 周开始接受 PEGIFN/RBV 联合治疗。
在 ivSIL 治疗 2 周后，HCV-RNA 和 HIV-RNA 均不可检测。在 ivSIL 单药治疗中，我们注意到 CD4+细胞计数增加和 HIV-RNA 减少的趋势。在 16 周后，由于不良反应，患者停止了 PEGIFN+RBV 的治疗。停药后 24 周，HCV-RNA 仍为阴性，而 HIV-RNA 恢复到基线水平。
ivSIL 可能是治疗 HIV-HCV 合并感染患者对 PEGIFN+RBV 联合治疗无反应的潜在治疗选择。需要进一步研究 ivSIL 对 CD4+细胞计数和 HIV-RNA 水平的可能有益影响。
