Department of Medicine I, University Hospital Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany.
Department of Medicine I, University Hospital Bonn, Sigmund-Freud-Str. 25, D-53127 Bonn, Germany.
Int J Antimicrob Agents. 2020 Jul;56(1):105527. doi: 10.1016/j.ijantimicag.2018.08.019. Epub 2018 Aug 23.
Direct-acting antivirals (DAAs) have tremendously improved the treatment of hepatitis C virus (HCV) infections also in human immunodeficiency virus (HIV)-positive individuals. Curing HCV infection is of particular importance in HIV-positive individuals as liver disease progression is accelerated in the course of concomitant HIV infection. Former challenges, such as safety and tolerability as well as reduced treatment uptake of pegylated interferon and ribavirin-based treatments, have been overcome with the approval of DAAs. Indeed, rates of discontinuation under modern all-oral DAA therapy in HIV/HCV coinfection have been reported to be <1%. Rates of sustained virological response (SVR) following treatment have aligned with those seen in HCV monoinfected patients, resulting in an equalisation of treatment recommendations for HCV monoinfected and HIV/HCV coinfected patients. Nevertheless, coinfection with HIV has been associated with slightly higher relapse rates in some real-world cohorts, arousing discussion regarding more individualised treatment once again. Moreover, an ongoing epidemic of acute HCV infections in HIV-positive men who have sex with men with high re-infection rates challenges physicians and researchers. The present review gives a concise summary of the remaining challenges in HCV treatment of HIV-positive individuals.
直接作用抗病毒药物（DAAs）极大地改善了丙型肝炎病毒（HCV）感染的治疗，也改善了人类免疫缺陷病毒（HIV）阳性个体的治疗。在 HIV 阳性个体中，治愈 HCV 感染尤为重要，因为在合并 HIV 感染的过程中，肝脏疾病的进展会加速。以前存在的一些挑战，如安全性和耐受性，以及聚乙二醇干扰素和利巴韦林为基础的治疗药物的接受率降低，已经随着 DAA 的批准而得到克服。事实上，在 HIV/HCV 合并感染的现代全口服 DAA 治疗中，停药率<1%。治疗后的持续病毒学应答（SVR）率与 HCV 单感染患者的应答率一致，导致 HCV 单感染和 HIV/HCV 合并感染患者的治疗建议趋于一致。然而，在一些真实世界的队列中，HIV 合并感染与略高的复发率相关，这再次引发了关于更个体化治疗的讨论。此外，HIV 阳性男男性行为者中急性 HCV 感染的持续流行，以及高再感染率，给医生和研究人员带来了挑战。本综述简要总结了 HIV 阳性个体 HCV 治疗中仍存在的挑战。
