University of British Columbia, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia;
University of Alberta, Edmonton, Alberta;
Can J Infect Dis Med Microbiol. 2014 Nov-Dec;25(6):311-20. doi: 10.1155/2014/251989.
Hepatitis C virus (HCV) coinfection occurs in 20% to 30% of Canadians living with HIV and is responsible for a heavy burden of morbidity and mortality. Management of HIV-HCV coinfection is more complex due to the accelerated progression of liver disease, the timing and nature of antiretroviral and HCV therapy, mental health and addictions management, socioeconomic obstacles and drug-drug interactions between new HCV direct-acting antiviral therapies and antiretroviral regimens.
To update national standards for the management of HCV-HIV coinfected adults in the Canadian context.
A standing working group with specific clinical expertise in HIV-HCV coinfection was convened by The Canadian Institute of Health Research HIV Trials Network to review recently published data regarding HCV antiviral treatments and to update the Canadian HIV-HCV coinfection guidelines.
Recent data suggest that the gap in sustained virological response rates between HCV monoinfection and HIV-HCV coinfection has been eliminated with newer HCV antiviral regimens. All HIV-HCV coinfected individuals should be assessed for HCV therapy. First-line treatment for genotypes 1 through 6 includes pegylated interferon and weight-based ribavirin dosing plus the nucleotide sofosbuvir for 12 weeks. Sofosbuvir in combination with the protease inhibitor simeprevir is another first-line consideration for genotype 1 infection. Sofosbuvir with ribavirin for 12 weeks (genotype 2) and 24 weeks (genotype 3) is also recommended as first-line treatment.
Recommendations may not supersede individual clinical judgement.
在加拿大，20%至 30%的 HIV 感染者同时感染丙型肝炎病毒（HCV），这给他们带来了沉重的疾病负担和死亡率。由于肝脏疾病的快速进展、抗逆转录病毒和 HCV 治疗的时机和性质、心理健康和成瘾管理、社会经济障碍以及新型 HCV 直接作用抗病毒治疗与抗逆转录病毒方案之间的药物相互作用，HIV-HCV 合并感染的管理更为复杂。
根据加拿大的具体情况，更新 HCV-HIV 合并感染成人管理的国家标准。
加拿大卫生研究院 HIV 试验网络的一个具有 HIV-HCV 合并感染特定临床专业知识的常设工作组，对最近发表的 HCV 抗病毒治疗数据进行了审查，并更新了加拿大 HIV-HCV 合并感染指南。
最近的数据表明，随着新型 HCV 抗病毒药物的出现，HCV 单感染和 HIV-HCV 合并感染的持续病毒学应答率差距已经消除。所有 HIV-HCV 合并感染者均应评估 HCV 治疗。基因型 1 至 6 的一线治疗包括聚乙二醇干扰素和基于体重的利巴韦林剂量加核苷酸索非布韦，疗程为 12 周。对于基因型 1 感染，索非布韦联合蛋白酶抑制剂西米普韦也可作为一线治疗方案。索非布韦联合利巴韦林，疗程为 12 周（基因型 2）和 24 周（基因型 3）也被推荐作为一线治疗。
这些建议可能无法取代个人临床判断。
