Department of Medicine I, University Hospital Bonn, Sigmund-Freud-Str, 25, 53105 Bonn, Germany.
BMC Med. 2013 Nov 1;11:234. doi: 10.1186/1741-7015-11-234.
Morbidity and mortality from co-morbid hepatitis C (HCV) infection in HIV co-infected patients are increasing; hence, the management of hepatitis co-infection in HIV is now one of the most important clinical challenges. Therefore, the development of direct acting antivirals (DAAs) for treatment of HCV has been eagerly awaited to hopefully improve HCV treatment outcome in co-infected individuals. Indeed, the availability of the first HCV protease inhibitors (PI) boceprevir and telaprevir for HCV genotype 1 patients has changed the gold standard of treating hepatitis C allowing for substantially improved HCV cure rates under triple HCV-PI/pegylated interferon/ribavirin therapy. Moreover, numerous other new DAAs are currently being studied in co-infected patient populations, also exploring shorter treatment durations and interferon-free treatment approaches promising much easier and better tolerated treatment regimens in the near future. Nevertheless, numerous challenges remain, including choice of patients to treat, potential for drug-drug interactions and overlapping toxicities between HIV and HCV therapy. The dramatically improved rates of HCV cure under new triple therapy, however, warrant evaluation of these new treatment options for all co-infected patients.
合并感染丙型肝炎（HCV）的 HIV 感染者的发病率和死亡率正在上升；因此，HIV 合并 HCV 感染的管理现在是最具挑战性的临床问题之一。因此，人们一直急切期待开发直接作用抗病毒药物（DAAs）来治疗 HCV，以提高合并感染者的 HCV 治疗效果。事实上，第一批 HCV 蛋白酶抑制剂（PI）博赛泼维（boceprevir）和特拉泼维（telaprevir）用于 HCV 基因型 1 患者，改变了 HCV 治疗的金标准，使得在三联 HCV-PI/聚乙二醇干扰素/利巴韦林治疗下，HCV 治愈率显著提高。此外，目前正在对合并感染患者人群中研究许多其他新的 DAAs，也在探索更短的治疗持续时间和无干扰素治疗方法，有望在不久的将来提供更简单、更耐受的治疗方案。尽管如此，仍存在许多挑战，包括治疗患者的选择、药物相互作用的可能性以及 HIV 和 HCV 治疗之间的重叠毒性。然而，新三联疗法显著提高 HCV 治愈率，因此需要对所有合并感染患者评估这些新的治疗选择。
