Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy.
J Antimicrob Chemother. 2013 Jan;68(1):193-9. doi: 10.1093/jac/dks341. Epub 2012 Sep 14.
To define the impact of coinfection with hepatitis B virus (HBV) or hepatitis C virus (HCV) on viroimmunological response to raltegravir-based salvage regimens that also include new HIV inhibitors such as maraviroc, darunavir and etravirine.
We used data from a national observational study of patients starting raltegravir-based regimens to compare virological suppression and CD4 cell change from baseline in patients with and without concomitant HBV or HCV infection.
Overall, 275 patients (107 coinfected and 168 non-coinfected) were evaluated. Coinfected patients were more commonly former intravenous drug users and had a longer history of HIV infection and higher baseline aminotransferase levels. Both HIV-RNA and CD4 response were similar in the two groups. Mean time to first HIV-RNA copy number <50 copies/mL was 4.1 months (95% CI 3.5-4.6) in non-coinfected patients and 3.9 months (95% CI 3.3-4.5) in coinfected patients (hazard ratio 1.039, 95% CI 0.761-1.418, P = 0.766, log-rank test). The risk of developing new grade 3-4 hepatic adverse events was significantly higher in coinfected patients (hazard ratio 1.779, 95% CI 1.123-2.817, P = 0.009). The two groups of coinfected and non-coinfected patients had similar rates of interruption of any baseline drug (hazard ratio 1.075, 95% CI 0.649-1.781, P = 0.776) and of raltegravir (hazard ratio 1.520, 95% CI 0.671-3.447, P = 0.311). Few AIDS-defining events and deaths occurred.
Viroimmunological response to regimens based on raltegravir and other recent anti-HIV inhibitors is not negatively affected by coinfection with HBV or HCV. Liver toxicity, either pre-existing or new, is more common in coinfected patients, but with no increased risk of treatment interruption.
确定乙型肝炎病毒（HBV）或丙型肝炎病毒（HCV）合并感染对拉替拉韦为基础的挽救治疗方案（该方案还包括新型 HIV 抑制剂，如马拉维若、达芦那韦和依曲韦林）的病毒学免疫反应的影响。
我们使用了一项全国性观察性研究的数据，该研究评估了开始拉替拉韦为基础的治疗方案的患者，比较了合并感染和未合并感染患者的病毒学抑制和 CD4 细胞从基线的变化。
共有 275 名患者（107 名合并感染，168 名未合并感染）接受了评估。合并感染的患者更常见于既往静脉吸毒者，且 HIV 感染史较长，基线转氨酶水平较高。两组的 HIV-RNA 和 CD4 反应均相似。未合并感染患者首次 HIV-RNA 拷贝数<50 拷贝/ml 的中位时间为 4.1 个月（95%CI 3.5-4.6），合并感染患者为 3.9 个月（95%CI 3.3-4.5）（风险比 1.039，95%CI 0.761-1.418，P=0.766，对数秩检验）。合并感染患者新发 3-4 级肝不良事件的风险明显更高（风险比 1.779，95%CI 1.123-2.817，P=0.009）。合并感染和未合并感染患者的任何基线药物（风险比 1.075，95%CI 0.649-1.781，P=0.776）和拉替拉韦（风险比 1.520，95%CI 0.671-3.447，P=0.311）的中断率相似。很少发生 AIDS 定义的事件和死亡。
拉替拉韦和其他新型抗 HIV 抑制剂为基础的治疗方案的病毒学免疫反应不受 HBV 或 HCV 合并感染的负面影响。合并感染患者更常见的是预先存在的或新的肝毒性，但治疗中断的风险没有增加。
