Poveda Eva, Vispo Eugenia, Barreiro Pablo, de Mendoza Carmen, Labarga Pablo, Fernández-Montero José Vicente, Martin-Carbonero Luz, Soriano Vincent
Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.
Antivir Ther. 2012;17(3):571-5. doi: 10.3851/IMP1992. Epub 2011 Dec 15.
Direct acting antivirals (DAAs) against HCV are eagerly awaited for HIV-HCV-coinfected individuals. However, the activity of first generation drugs is limited to HCV genotype 1 and is lower in cirrhotics, subtype 1a infections, prior interferon (IFN)-α exposure or unfavourable IL28B alleles. Herein, we report the current profile of HIV-HCV-coinfected patients at our institution in an attempt to predict the effect of DAAs.
All HIV-HCV-coinfected patients seen at our HIV outpatient clinic in 2011 were identified. Information on serum HCV RNA, HCV genotype/subtype, plasma HIV RNA, prior IFN-α experience, liver fibrosis staging and IL28B alleles was recorded.
A total of 424 HIV-HCV-coinfected patients were identified, of whom 174 (41%) were IFN-α-experienced. Mean serum HCV RNA was 6 log IU/ml. HCV genotype/subtype distribution was 166 (39.1%) G1a, 93 (22%) G1b, 85 (20%) G4, 49 (11.5%) G3 and 1 (<1%) G2, and 30 (7%) were unclassified. Of note, 56% of G1a were prior IFN-α-experienced patients. Overall, 37% had advanced liver fibrosis (Metavir score estimates F3-F4). Finally, 70% harboured unfavourable IL28B alleles.
The current profile of HIV-HCV-coinfected patients in Spain is dominated by particularly difficult-to-treat individuals, such as those infected with G1a or G4 (59%), advanced liver fibrosis (37%) and unfavourable IL28B alleles (70%). A wide use of prior anti-HCV therapy in our region most likely has resulted in hepatitis C cure of more IFN-α susceptible individuals, with accumulation of a more refractory treatment population. Thus, the use of DAAs in HIV-HCV-coinfected patients will require particular expertise and their benefit might be lower than expected.
针对丙型肝炎病毒（HCV）的直接抗病毒药物（DAAs）备受HIV-HCV合并感染患者期待。然而，第一代药物的活性仅限于HCV基因1型，在肝硬化患者、1a亚型感染、既往接受过干扰素（IFN）-α治疗或携带不利的IL28B等位基因的患者中活性较低。在此，我们报告了我院HIV-HCV合并感染患者的当前情况，以试图预测DAAs的疗效。
确定了2011年在我院HIV门诊就诊的所有HIV-HCV合并感染患者。记录血清HCV RNA、HCV基因/亚型、血浆HIV RNA、既往IFN-α治疗史、肝纤维化分期及IL28B等位基因的相关信息。
共确定424例HIV-HCV合并感染患者，其中174例（41%）有IFN-α治疗史。血清HCV RNA平均水平为6 log IU/ml。HCV基因/亚型分布为：166例（39.1%）G1a型，93例（22%）G1b型，85例（20%）G4型，49例（11.5%）G3型，1例（<1%）G2型，30例（7%）未分类。值得注意的是，G1a型患者中有56%有IFN-α治疗史。总体而言，37%患者有晚期肝纤维化（梅塔维分级为F3-F4）。最后，70%患者携带不利的IL28B等位基因。
西班牙目前HIV-HCV合并感染患者的情况以特别难以治疗的个体为主，如感染G1a或G4型（59%）、有晚期肝纤维化（37%）及携带不利的IL28B等位基因（70%）的患者。在我们地区广泛使用既往抗HCV治疗很可能使更多对IFN-α敏感的个体实现丙型肝炎治愈，导致更难治疗的患者群体累积。因此，在HIV-HCV合并感染患者中使用DAAs需要特殊专业知识，其获益可能低于预期。
