AP-HP, Département de Maladies Infectieuses et Tropicales, INSERM U720, CHU Pitié-Salpêtrière, Paris, France.
J Antimicrob Chemother. 2010 Nov;65(11):2445-9. doi: 10.1093/jac/dkq320. Epub 2010 Sep 2.
To compare plasma antiretroviral concentrations in HIV-HCV co-infected and in matched HIV mono-infected patients.
This was a cross-sectional, observational study. Antiretroviral trough concentrations (C(min)) in plasma were measured in HIV-HCV co-infected patients with liver disease documented by liver biopsy, matched with HIV mono-infected patients according to gender and antiretroviral treatment. C(min) values in serum were measured using an HPLC method. Statistical analysis was performed using the Wilcoxon test.
Seventy-three HIV-HCV co-infected patients and 66 HIV-infected patients were enrolled; 70% of patients were receiving a protease inhibitor (PI)- and 30% a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. Among the 73 co-infected patients, 27 had a fibrosis score (Fibrotest(®)) of F4. Abacavir was the only nucleoside reverse transcriptase inhibitor whose trough concentrations differed between the co-infected and mono-infected groups. PI median plasma C(min) values were not different in the two groups, except for lopinavir, with a lower C(min) in the co-infected group than in the HIV-infected group (median 3673 versus 5990 ng/mL, P=0.04), and nelfinavir, with significantly higher concentrations in the co-infected group. Seventy-five percent of co-infected patients scoring F4, 33% of those scoring F0-F3 and 12% of HIV-infected patients were underdosed (P=0.02). Co-infected patients receiving an NNRTI had a higher plasma C(min) than HIV-infected patients; median C(min) was 3583 versus 1494 ng/mL (P=0.025) and 5331 versus 3954 ng/mL (P=0.10) for efavirenz and nevirapine, respectively. Overall, there was a greater proportion of co-infected patients with high concentrations of both NNRTIs (15/23) compared with HIV mono-infected patients (5/21) (P=0.008), especially in co-infected patients with an advanced liver fibrosis stage.
Median plasma C(min) values differed significantly between HIV and HIV-HCV co-infected patients for abacavir, lopinavir and efavirenz. NNRTIs were strongly overdosed in HIV-HCV co-infected patients.
比较 HIV-HCV 合并感染和匹配的 HIV 单感染患者的血浆抗逆转录病毒浓度。
这是一项横断面、观察性研究。对经肝活检证实患有肝病的 HIV-HCV 合并感染患者进行血浆抗逆转录病毒谷浓度（C(min)）检测，并根据性别和抗逆转录病毒治疗与 HIV 单感染患者进行匹配。使用 HPLC 法测量血清中的 C(min) 值。使用 Wilcoxon 检验进行统计分析。
共纳入 73 例 HIV-HCV 合并感染患者和 66 例 HIV 感染患者；70%的患者接受基于蛋白酶抑制剂（PI）和 30%基于非核苷类逆转录酶抑制剂（NNRTI）的治疗方案。在 73 例合并感染患者中，有 27 例纤维性指标（Fibrotest(®)）为 F4。只有阿巴卡韦的谷浓度在合并感染组和单感染组之间存在差异。两组患者的 PI 中位血浆 C(min) 值无差异，除了洛匹那韦，合并感染组的 C(min) 值低于 HIV 感染组（中位数分别为 3673 与 5990ng/ml，P=0.04），以及奈韦拉平，合并感染组的浓度显著更高。75%的 F4 评分的合并感染患者、33%的 F0-F3 评分的合并感染患者和 12%的 HIV 感染患者存在剂量不足（P=0.02）。接受 NNRTI 的合并感染患者的血浆 C(min) 高于 HIV 感染患者；依非韦伦和依法韦仑的中位 C(min) 分别为 3583 与 1494ng/ml（P=0.025）和 5331 与 3954ng/ml（P=0.10）。总体而言，与 HIV 单感染患者相比（5/21），接受 NNRTI 治疗的合并感染患者中具有高浓度 NNRTI 的比例更高（15/23）（P=0.008），尤其是在合并感染患者存在晚期肝纤维化阶段时。
阿巴卡韦、洛匹那韦和依非韦伦的 HIV 和 HIV-HCV 合并感染患者的中位血浆 C(min) 值存在显著差异。HIV-HCV 合并感染患者的 NNRTI 剂量明显过高。
