Département d'Infectiologie, CHU and Université de Bourgogne, 10 boulevard du Maréchal de Lattre de Tassigny, 21079 Dijon Cedex France. lionel.piroth@chu- dijon.fr
Clin Res Hepatol Gastroenterol. 2011 Dec;35 Suppl 2:S75-83. doi: 10.1016/S2210-7401(11)70012-2.
Nearly three-quarters of human immunodeficiency virus-hepatitis C virus (HIV-HCV) coinfected patients in France currently need to be cured of their chronic HCV infection. The increase in sustained virological response rates obtained with the recently available HCV protease inhibitors in treatment-naïve genotype-1 patients has generated considerable hope in these co-infected patients. However, several particularities (such as a higher baseline HCV load, more advanced liver fibrosis, frequent co-morbidities, and the risk of toxicity and drug-drug interactions) have not allowed the direct extrapolation of the results observed in HCV-monoinfected patients to patients with HIV-HCV co-infection. Yet, despite these uncertainties and the little available data from ongoing trials, several proposals can be made not only because the patients and drugs are ready and waiting, but also because the clock is ticking. In general, it can be advocated that HCV triple therapy should be offered to most HIV-infected patients with advanced liver fibrosis, but should be deferred or discussed on a case-by-case basis in those with mild-to-moderate fibrosis. However, such proposals rely on a relatively small amount of evidence and many questions are still pending, as studies in HIV-HCV co-infected patients have been late in coming and are several years behind those in HCV-monoinfected patients. Thus, this situation, in the context of more rapid and more severe infection, and lower response rates with standard care (pegylated interferon and ribavirin), along with the many potential drug-drug interactions (particularly with antiretroviral therapy), underscores the need for earlier evaluation of new strategies, schedules and new direct-acting antivirals in HIV-infected patients.
目前，法国近四分之三的人类免疫缺陷病毒-丙型肝炎病毒（HIV-HCV）合并感染患者需要治愈其慢性 HCV 感染。最近可用的 HCV 蛋白酶抑制剂在治疗初治基因型 1 患者中获得的持续病毒学应答率的提高，使这些合并感染患者产生了极大的希望。然而，一些特殊情况（如基线 HCV 载量较高、更严重的肝纤维化、经常合并存在的疾病以及毒性和药物相互作用的风险）使得不能直接将 HCV 单感染患者中观察到的结果外推到 HIV-HCV 合并感染患者。然而，尽管存在这些不确定性和来自正在进行的试验的有限数据，仍可以提出一些建议，不仅因为患者和药物已经准备就绪，而且因为时间紧迫。一般来说，可以主张对大多数有晚期肝纤维化的 HIV 感染患者提供 HCV 三联疗法，但对于纤维化程度较轻至中度的患者，应推迟或根据具体情况进行讨论。然而，这些建议依赖于相对较少的证据，并且仍有许多问题悬而未决，因为 HIV-HCV 合并感染患者的研究进展缓慢，比 HCV 单感染患者的研究落后数年。因此，在更快速和更严重的感染、标准治疗（聚乙二醇干扰素和利巴韦林）的应答率较低以及许多潜在的药物相互作用（特别是与抗逆转录病毒治疗）的情况下，需要更早地评估新策略、方案和新的直接作用抗病毒药物在 HIV 感染患者中的应用。
