Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.
Semin Liver Dis. 2012 May;32(2):138-46. doi: 10.1055/s-0032-1316469. Epub 2012 Jul 3.
Progression to cirrhosis occurs faster whereas response to peginterferon/ribavirin therapy is lower in patients with chronic hepatitis C coinfected with human immunodeficiency virus (HIV), as compared with hepatitis C virus (HCV) monoinfected individuals. The use of antiretroviral therapy may ameliorate poor outcomes in HIV/HCV coinfected patients. However, in the best scenario peginterferon/ribavirin therapy provides cure to 30% of patients harboring HCV genotypes 1 or 4 and to 70% of HCV genotypes 2 or 3 carriers, a rate lower than that seen in HCV monoinfection. Moreover, a substantial proportion of HIV/HCV coinfected patients are not treated due to contraindications, or do not complete therapy due to serious adverse events, or just do not wish to receive such a poorly tolerated medication. For these reasons, the advent of direct acting antivirals (DAA) has been eagerly awaited for treating HIV/HCV coinfected patients. However, new challenges have arisen, including the potential for harmful drug interactions with antiretroviral agents, poor drug adherence due to polymedication, increased risk for selection of drug-resistant HCV mutants, and unaffordable coverage in an environment of economic constraints. The use of noninvasive tools to measure liver fibrosis (i.e., elastometry) and pharmacogenomics (testing for IL28B and perhaps ITPA polymorphisms), along with consideration of early viral kinetics to guide length and drugs needed could help to individualize and improve the cost effectiveness of therapeutic decisions using DAA in HIV-infected patients with chronic hepatitis C.
与单纯丙型肝炎病毒（HCV）感染者相比，合并人类免疫缺陷病毒（HIV）感染的慢性丙型肝炎患者进展为肝硬化的速度更快，对聚乙二醇干扰素/利巴韦林治疗的反应更低。抗逆转录病毒治疗的应用可能改善 HIV/HCV 合并感染患者的不良预后。然而，在最佳情况下，聚乙二醇干扰素/利巴韦林治疗可治愈 30%的携带 HCV 基因型 1 或 4 的患者和 70%的携带 HCV 基因型 2 或 3 的患者，这一比例低于 HCV 单纯感染患者。此外，由于禁忌证，相当一部分 HIV/HCV 合并感染患者未接受治疗，或因严重不良事件未完成治疗，或只是不愿接受这种耐受性差的药物。由于这些原因，人们急切期待直接作用抗病毒药物（DAA）的出现来治疗 HIV/HCV 合并感染患者。然而，新的挑战已经出现，包括与抗逆转录病毒药物发生有害药物相互作用的可能性、由于多药治疗而导致的药物依从性差、选择耐药 HCV 突变体的风险增加以及在经济限制的环境下无法负担的药物覆盖范围。使用非侵入性工具（如瞬时弹性成像）测量肝纤维化和药物基因组学（检测 IL28B 和可能的 ITPA 多态性），并考虑早期病毒动力学以指导所需的治疗时间和药物，可能有助于个体化并提高使用 DAA 治疗 HIV 感染合并慢性丙型肝炎患者的成本效益。
