Vispo Eugenia, Barreiro Pablo, Plaza Zulema, Fernández-Montero Jose Vicente, Labarga Pablo, de Mendoza Carmen, Sierra-Enguita Rocío, Treviño Ana, Lopez Mariola, Soriano Vicente
Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.
AIDS. 2014 Jun 19;28(10):1473-8. doi: 10.1097/QAD.0000000000000275.
A quarter of individuals acutely infected with hepatitis C virus (HCV) clear the virus spontaneously. Once chronic infection is established, HCV elimination generally can only be achieved using specific antiviral therapy, such as peg-interferon-ribavirin. Herein, we report a group of chronically HIV/HCV-coinfected patients that cleared HCV spontaneously while being treated only with antiretrovirals.
Retrospective analysis of all HIV-infected individuals with positive HCV antibodies (HCV-Abs) and negative serum HCV-RNA seen during 2012 at a reference HIV clinic in Madrid.
From a total of 2366 HIV-infected individuals, 618 (26%) were HCV-Ab+, of whom 387 (62%) were positive for serum HCV-RNA. Individuals HCV-Ab+/HCV-RNA-negative were grouped into two categories--those that had eliminated HCV following a course of antiviral treatment (n = 198, 86%) and those who had cleared the virus spontaneously (n = 33, 14%). Eight with spontaneous clearance were HBsAg+ and might have cleared HCV as a result of viral interference. However, six (24%) out of the remaining 25 did so after being serum HCV-RNA+ for longer than 6 months (median 5.6 years, range 1.3-12 years). All harbored alleles and had undetectable plasma HIV-RNA on HAART around the time of HCV clearance.
Spontaneous HCV clearance may occur in a subset of chronically HIV/HCV-coinfected patients on HAART harboring IL28B-CC. Given that antiretrovirals do not display any direct anti-HCV activity, recovery of innate immune responses could be responsible for these late HCV clearance episodes. Thus, periodic testing of serum HCV-RNA may be warranted in chronically HIV/HCV-coinfected patients on HAART harboring IL28B-CC alleles.
四分之一的急性丙型肝炎病毒（HCV）感染者可自发清除病毒。一旦确立慢性感染，通常只有使用特定的抗病毒疗法，如聚乙二醇干扰素-利巴韦林，才能实现HCV清除。在此，我们报告一组慢性HIV/HCV合并感染患者，他们在仅接受抗逆转录病毒治疗时自发清除了HCV。
对2012年在马德里一家HIV参考诊所就诊的所有HCV抗体（HCV-Abs）阳性且血清HCV-RNA阴性的HIV感染者进行回顾性分析。
在总共2366例HIV感染者中，618例（26%）HCV-Ab阳性，其中387例（62%）血清HCV-RNA阳性。HCV-Ab+/HCV-RNA阴性的个体分为两类——在接受一个疗程的抗病毒治疗后清除HCV的个体（n = 198，86%）和自发清除病毒的个体（n = 33，14%）。8例自发清除者HBsAg阳性，可能由于病毒干扰而清除了HCV。然而，其余25例中的6例（24%）在血清HCV-RNA阳性超过6个月后（中位数5.6年，范围1.3 - 12年）实现了清除。所有患者均携带相关等位基因，并且在HCV清除时接受高效抗逆转录病毒治疗（HAART），血浆HIV-RNA检测不到。
在接受HAART且携带IL28B-CC的慢性HIV/HCV合并感染患者亚组中可能会出现自发HCV清除。鉴于抗逆转录病毒药物不具有任何直接抗HCV活性，固有免疫反应的恢复可能是这些晚期HCV清除事件的原因。因此，对于携带IL28B-CC等位基因且接受HAART的慢性HIV/HCV合并感染患者，可能有必要定期检测血清HCV-RNA。
