Center for Systemic Manifestations of Hepatitis Viruses (MASVE), Department of Internal Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
J Transl Med. 2012 Aug 3;10:158. doi: 10.1186/1479-5876-10-158.
The relationship between Hepatitis C Virus (HCV) infection and immunosuppression is complex and multifaceted. Although HCV-related hepatocytolysis is classically interpreted as secondary to the attack by cytotoxic T lymphocytes against infected cells, the liver disease is usually exacerbated and more rapidly evolutive in immunosuppressed patients. This generally occurs during the immunosuppression state, and not at the reconstitution of the host response after immunosuppressive therapy discontinuation. The field of immunosuppression and HCV infection is complicated both by the different outcome observed in different situations and/or by contrasting data obtained in the same conditions, with several still unanswered questions, such as the opportunity to modify treatment schedules in the setting of post-transplant follow-up. The complexity of this field is further complicated by the intrinsic tendency of HCV infection in itself to lead to disorders of the immune system. This review will briefly outline the current knowledge about the pathogenesis of both hepatic and extrahepatic HCV-related disorders and the principal available data concerning HCV infection in a condition of impairment of the immune system. Attention will be especially focused on some conditions - liver or kidney transplantation, the use of biologic drugs and cancer chemotherapy - for which more abundant and interesting data exist.
丙型肝炎病毒 (HCV) 感染与免疫抑制之间的关系是复杂和多方面的。虽然 HCV 相关的肝细胞溶解被经典地解释为细胞毒性 T 淋巴细胞对感染细胞的攻击的继发结果，但在免疫抑制患者中，肝脏疾病通常会加重并且更快速地进展。这种情况通常发生在免疫抑制状态期间，而不是在免疫抑制治疗停止后宿主反应重建时。免疫抑制和 HCV 感染领域的复杂性既体现在不同情况下观察到的不同结果上，也体现在同一情况下获得的相互矛盾的数据上，还有几个尚未解决的问题，例如在移植后随访中是否有机会修改治疗方案。该领域的复杂性因 HCV 感染本身导致免疫系统紊乱的内在趋势而进一步复杂化。这篇综述将简要概述目前关于 HCV 相关肝内和肝外疾病发病机制的知识，以及关于免疫系统受损时 HCV 感染的主要现有数据。将特别关注一些情况 - 肝或肾移植、生物药物和癌症化疗的使用 - 这些情况存在更丰富和更有趣的数据。
