1 Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna , Vienna, Austria .
AIDS Patient Care STDS. 2014 May;28(5):221-7. doi: 10.1089/apc.2013.0359.
The aim of this study was to assess the therapeutic potential of telaprevir (TPV)/boceprevir (BOC)-based triple-therapy in a complete cohort of HIV/chronic hepatitis C co-infected patients (HIV/HCV). Moreover, a case series of four HIV/HCV genotype (HCV-GT)1 patients with rapid virologic response (RVR), who received only 28 weeks of BOC-based triple-therapy (BOCW28), was reported. 290/440 HIV-positive patients with positive HCV serology had at least one visit during the past 2 years, 142/290 had target detectable HCV-RNA with 64% (82/142) carrying HCV-GT1. While 18 HIV/HCV-GT1 displayed contraindications, 45% (64/142) of HIV/HCV were eligible for triple-therapy. Insufficiently controlled HIV-infection despite combined antiretroviral therapy (cART) (HIV-RNA <50 copies/mL: 73% vs. 22%; p<0.001) and liver cirrhosis (31% vs. 8%; p=0.025) were overrepresented among patients with contraindications for triple-therapy. Low treatment uptake rates (39% (25/64)) during the first 2 years of triple-therapy availability suggest that its benefit in HIV/HCV co-infected patients might fall short of expectations. Modification of cART or TPV dose adjustment would have been necessary in 61% and 84% of HIV/HCV-GT1 on cART eligible for triple-therapy using TPV and BOC, respectively, suggesting that drug-drug interactions with cART complicate management in the majority of patients. All four BOCW28 patients achieved a sustained virologic response. Prospective studies are necessary to validate our observations on the shortening of treatment duration in HIV/HCV-GT1 with RVR.
本研究旨在评估替拉瑞韦（TPV）/博赛匹韦（BOC）三联疗法在完全合并感染 HIV/慢性丙型肝炎病毒（HCV）患者中的治疗潜力。此外，报告了四例 HIV/HCV 基因型（HCV-GT）1 且快速病毒学应答（RVR）患者的病例系列，他们仅接受了 28 周的 BOC 三联疗法（BOCW28）。在过去的 2 年中，440 名 HIV 阳性患者中有 290 名至少有一次就诊，其中 142 名患者的 HCV-RNA 可检测到，64%（82/142）的患者携带 HCV-GT1。尽管有 18 名 HIV/HCV-GT1 存在禁忌证，但 45%（64/142）的 HIV/HCV 患者符合三联疗法的条件。尽管接受了联合抗逆转录病毒治疗（cART），但 HIV 感染仍未得到充分控制（HIV-RNA <50 拷贝/ml：73%比 22%；p<0.001）和肝硬化（31%比 8%；p=0.025）在有三联疗法禁忌证的患者中更为常见。在三联疗法可用的头 2 年中，治疗的接受率很低（39%（25/64）），这表明其在 HIV/HCV 合并感染患者中的益处可能低于预期。在适合接受 TPV 和 BOC 的三联疗法的 HIV/HCV-GT1 患者中，有 61%和 84%需要调整 cART 或 TPV 剂量，这表明与 cART 的药物相互作用使大多数患者的管理复杂化。所有四名接受 BOCW28 的患者均获得了持续病毒学应答。有必要进行前瞻性研究来验证我们在 RVR 的 HIV/HCV-GT1 中缩短治疗时间的观察结果。
