Hôpital Cochin Saint Vincent de Paul, Unité d'Hépatologie, Inserm U.1016, Université Paris Descartes, Paris, France.
Liver Int. 2011 Jan;31 Suppl 1:135-9. doi: 10.1111/j.1478-3231.2010.02394.x.
The combination of antiretroviral (ARV) therapies introduced at the end of the 1990s profoundly changed the natural history of human immunodeficiency virus (HIV) infection. Liver diseases are one of the three primary causes of 'non-AIDS-related' death in people living with HIV for three reasons: the high prevalence of hepatotropic viral co-infections, the hepatotoxicity of ARV drugs and new emerging liver diseases, including nodular regenerative hyperplasia and hepatitis E virus infection. The impact of HIV infection on the natural history of hepatitis C virus (HCV) or hepatitis B virus (HBV)/HIV co-infection has markedly changed in the past few decades with the progress made in ARV treatment and the improved definition of therapeutic strategies for HCV or HBV. Initially, HIV had a negative impact on hepatotropic infections. Today, HIV does not appear to significantly modify the natural history of HCV and HBV infection. This is associated with fair immune restoration, viral suppression associated with analogues having dual activity against HBV and HIV and with the increasing efficacy of antiviral treatments against HCV. A significant decline is expected in the morbidity and mortality associated with chronic liver infection in co-infected patients. Nevertheless, today, there are three major issues: (i) improving preventive measures including vaccination and risk reduction; (ii) screening patients infected with HBV or HCV and evaluating the impact of chronic infection on the liver and finally; (iii) early screening of hepatocellular carcinoma whose occurrence is higher and that evolves more rapidly in co-infected than in mono-infected patients.
抗逆转录病毒（ARV）疗法于 20 世纪 90 年代末问世，深刻改变了人类免疫缺陷病毒（HIV）感染的自然史。肝脏疾病是 HIV 感染者“非艾滋病相关”死亡的三个主要原因之一，原因有三：嗜肝病毒合并感染的高发率、ARV 药物的肝毒性以及包括结节性再生性增生和戊型肝炎病毒感染在内的新出现的肝脏疾病。在过去几十年中，随着 ARV 治疗的进步和 HCV 或 HBV/HIV 合并感染治疗策略的改善，HIV 感染对丙型肝炎病毒（HCV）或乙型肝炎病毒（HBV）/HIV 合并感染自然史的影响发生了显著变化。最初，HIV 对嗜肝感染有负面影响。如今，HIV 似乎并未显著改变 HCV 和 HBV 感染的自然史。这与良好的免疫恢复、与同时具有抗 HBV 和 HIV 活性的类似物相关的病毒抑制以及抗 HCV 抗病毒治疗疗效的提高有关。预计合并感染患者的慢性肝脏感染相关发病率和死亡率将显著下降。然而，目前仍存在三个主要问题：（i）改善包括疫苗接种和减少风险在内的预防措施；（ii）筛查感染 HBV 或 HCV 的患者并评估慢性感染对肝脏的影响；最后；（iii）早期筛查肝细胞癌，其在合并感染患者中发生率更高且进展更快。
