Department of Internal Medicine I, University of Bonn, Bonn, Germany.
Curr Opin HIV AIDS. 2011 Nov;6(6):459-64. doi: 10.1097/COH.0b013e32834b87de.
Almost 10 years ago clinicians started to note first cases of an outbreak of acute hepatitis C (AHC) infections among HIV-positive men who have sex with men (MSM) in Europe, soon followed by similar reports from the USA and Australia. To date, no randomized controlled treatment trials in AHC co-infection have been conducted. However, to give clinicians guidance in best clinical management of these patients expert consensus recommendations based upon published data from uncontrolled clinical and cohort studies have recently been published.
The early course of hepatitis C virus (HCV) RNA in the first 4 weeks after diagnosis is considered to be a helpful predictor of spontaneous clearance of AHC in HIV-infected individuals. Additionally, single-nucleotide polymorphisms near the IL28B gene further augment chances of spontaneous clearance. Pegylated interferon in combination with weight-adapted ribavirin is still recommended as treatment of choice for all HCV genotypes. For patients developing a rapid virological response (RVR), defined as a negative HCV-RNA in an ultrasensitive assay, treatment duration of 24 weeks is recommended. If antiviral therapy was initiated within 24 weeks after diagnosis high sustained virological response (SVR) rates of 60-80% have been observed.
Prevention and screening efforts along with early anti-HCV therapy have to be intensified to allow control of viral dissemination as the current epidemic of AHC particularly among MSM is still ongoing. Concise recommendations for best clinical management of AHC in HIV infection on the basis of published observational data have been published.
目的综述：近 10 年前，临床医生开始注意到在欧洲 HIV 阳性男男性行为者（MSM）中首次出现急性丙型肝炎（AHC）感染暴发的病例，随后美国和澳大利亚也报告了类似的病例。迄今为止，尚未在 AHC 合并感染中进行随机对照治疗试验。然而，为了为临床医生提供最佳的临床管理指导，最近根据未经对照的临床和队列研究发表的数据发布了专家共识建议。
最新发现：诊断后 4 周内丙型肝炎病毒（HCV）RNA 的早期过程被认为是 HIV 感染者自发性清除 AHC 的有用预测指标。此外，IL28B 基因附近的单核苷酸多态性进一步增加了自发性清除的机会。聚乙二醇干扰素联合体重调整利巴韦林仍被推荐作为所有 HCV 基因型的治疗选择。对于发生快速病毒学应答（RVR）的患者，定义为超敏检测 HCV-RNA 阴性，建议治疗时间为 24 周。如果在诊断后 24 周内开始抗病毒治疗，观察到高持续病毒学应答（SVR）率为 60-80%。
总结：必须加强预防和筛查工作以及早期抗 HCV 治疗，以控制病毒传播，因为目前 AHC 特别是在 MSM 中的流行仍在继续。根据发表的观察性数据，发表了关于 HIV 感染中 AHC 的最佳临床管理的简明建议。
