Klein Marina B, Rollet Kathleen C, Hull Mark, Cooper Curtis, Walmsley Sharon, Conway Brian, Pick Neora
Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, McGill University Health Centre, Montreal, Canada.
Antivir Ther. 2013;18(5):717-21. doi: 10.3851/IMP2484. Epub 2012 Dec 4.
The recent availability of new direct-acting antivirals (DAAs) for HCV treatment, which significantly increase sustained virological response rates for genotype 1 HCV infection, has brought new optimism with respect to curative HCV treatment for HIV-HCV-coinfected patients. We describe the characteristics of coinfected patients who could be eligible for DAAs to determine potential challenges facing clinicians and patients hoping to take advantage of these new therapies.
We evaluated the sociodemographic and clinical characteristics of the genotype 1 HCV-HIV-infected participants in a Canadian prospective multicentre cohort study at their most recent visit to assess potential eligibility for combination HCV treatment with boceprevir or telaprevir.
Of the 1,020 coinfected participants enrolled in the cohort, 707 (85%) had evidence of chronic HCV infection (HCV-RNA-positive), of whom 497 (70%) were infected with genotype 1; 375 (75%) were naive to HCV treatment and 122 (25%) had previously received therapy and failed. Only 143 (38%) of HCV treatment-naive and 39 (32%) of treatment-experienced participants had no absolute contraindications for treatment. Alcohol abuse, active depression and decompensated liver disease were the most frequent reasons for treatment ineligibility. The majority would require alterations in antiretroviral regimens to avoid important drug-drug interactions.
Although the need for curative HCV therapy in HIV-HCV coinfection is great, the actual number of patients who could be eligible for DAAs at the present time may be quite low. There remains an urgent need to develop safe, simple and interferon-sparing treatments for coinfected individuals.
近期用于丙肝治疗的新型直接抗病毒药物（DAA）的出现，显著提高了1型丙肝病毒感染的持续病毒学应答率，这为治愈合并感染丙肝病毒的HIV患者带来了新的希望。我们描述了符合使用DAA条件的合并感染患者的特征，以确定临床医生和希望利用这些新疗法的患者面临的潜在挑战。
我们在一项加拿大前瞻性多中心队列研究中，评估了1型丙肝病毒-艾滋病毒合并感染参与者在最近一次就诊时的社会人口统计学和临床特征，以评估其接受博赛匹韦或特拉匹韦联合丙肝治疗的潜在适宜性。
在该队列中登记的1020名合并感染参与者中，707名（85%）有慢性丙肝感染证据（丙肝病毒核糖核酸阳性），其中497名（70%）感染1型病毒；375名（75%）未接受过丙肝治疗，122名（25%）曾接受治疗但失败。在未接受过丙肝治疗的参与者中，只有143名（38%）和接受过治疗的参与者中39名（32%）没有绝对治疗禁忌证。酗酒、活动性抑郁和失代偿性肝病是最常见的治疗不适宜原因。大多数人需要调整抗逆转录病毒治疗方案以避免重要的药物相互作用。
虽然合并感染丙肝病毒的HIV患者对治愈性丙肝治疗的需求很大，但目前符合使用DAA条件的实际患者数量可能相当少。仍迫切需要为合并感染个体开发安全、简单且无需使用干扰素的治疗方法。
