AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Field Epidemiology Training Program Japan, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan; Global Infectious Diseases of Infection and Epidemiology, Medical Sciences Doctoral Program, Graduate School of Medicine, Tohoku University, Miyagi, Japan.
AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for AIDS Research, Kumamoto University, Kumamoto, Japan.
PLoS One. 2014 Jun 19;9(6):e100517. doi: 10.1371/journal.pone.0100517. eCollection 2014.
HCV co-infection is a poor prognostic factor in HIV-1-infected patients. Although the number of newly reported patients who show seroconversion is increasing, the clinical features are still unclear, especially in Asian countries.
A single-center retrospective cohort study of patients diagnosed between 2001-2012.
Acute hepatitis C (AHC) was diagnosed upon detection of high serum ALT (>100 IU) followed by anti-HCV seroconversion. Clinical characteristics, HIV-1-related immunological status and IL-28B genotypes (rs12979860, rs8099917) were collected. We compared these variables between patients with and without spontaneous clearance of HCV and between responders and non-responders to treatment with pegylated interferon (PEG-IFN) plus ribavirin.
Thirty-five patients were diagnosed with AHC during the study period. The majority (96.9%) were MSM. Three were lost to follow-up. Seventy-five percent of patients with AHC (24/32) were asymptomatic and found incidentally to have high serum ALT. Compared to those who did not show spontaneous clearance, patients with spontaneous HCV viral clearance showed more symptoms and more severe abnormalities related to acute hepatitis. Spontaneous clearance was seen in 4 out of 28 patients with CC+TT genotype, but not in 6 patients with IL-28B CT+TG genotype. PEG-IFN plus ribavirin treatment was initiated in 12 out of 28 cases without spontaneous clearance. The sustained virological response rate was high (81.8%, 9/11), even in cases with CT+TG genotype infected with HCV genotype 1b (SVR 2/2).
Careful attention to AHC is needed in HIV-1-infected MSM. Early diagnosis and PEG-IFN plus ribavirin treatment should be considered for AHC cases.
HCV 合并感染是 HIV-1 感染患者的一个不良预后因素。尽管新报告的血清学转换患者数量在增加，但临床特征仍不清楚，特别是在亚洲国家。
一项对 2001 年至 2012 年间确诊的患者进行的单中心回顾性队列研究。
急性丙型肝炎（AHC）的诊断依据为血清 ALT（>100IU）升高，随后抗 HCV 血清学转换。收集临床特征、HIV-1 相关免疫状态和 IL-28B 基因型（rs12979860、rs8099917）。我们比较了这些变量在 HCV 自发清除患者和聚乙二醇干扰素（PEG-IFN）联合利巴韦林治疗应答者和无应答者之间的差异。
研究期间共诊断出 35 例 AHC 患者。大多数（96.9%）为男男性行为者（MSM）。3 例失访。75%（24/32）的 AHC 患者无症状，偶然发现血清 ALT 升高。与未自发清除 HCV 的患者相比，自发清除 HCV 的患者症状更多，与急性肝炎相关的异常更严重。在 CC+TT 基因型的 28 例患者中有 4 例自发清除，而 IL-28B CT+TG 基因型的 6 例患者没有自发清除。28 例无自发清除的患者中有 12 例开始接受 PEG-IFN 联合利巴韦林治疗。即使在感染 HCV 基因型 1b 的 CT+TG 基因型患者中，持续病毒学应答率也很高（81.8%，9/11）。
HIV-1 感染的 MSM 中应密切关注 AHC。对于 AHC 患者，应早期诊断并考虑使用 PEG-IFN 联合利巴韦林治疗。
