接受抗逆转录病毒治疗的合并人类免疫缺陷病毒和丙型肝炎病毒感染的肾移植受者：我们的经验报告及文献综述
Direct-Acting Antiretroviral Therapy in Renal Transplant Recipients With Human Immunodeficiency Virus-Hepatitis C Virus Coinfection: Report of Our Experience and Literature Review.
作者信息
Moreno-Ramirez Manuela, Villanego Florentino, Vigara Luis Alberto, Cazorla Juan Manuel, Naranjo Javier, Garcia Teresa, Merino M Jose, Mazuecos Auxiliadora
机构信息
Department of Nephrology, Hospital Juan Ramón Jiménez, Huelva, Spain.
Department of Nephrology, Hospital Puerta del Mar, Cadiz, Spain.
出版信息
Transplant Proc. 2020 Mar;52(2):523-526. doi: 10.1016/j.transproceed.2019.12.009. Epub 2020 Feb 6.
UNLABELLED
A minor graft and patient survival are described in renal transplant recipients with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) coinfection than in recipients infected with only HIV. The high efficacy of direct-acting antivirals could improve the results. The experience reported in renal transplant recipients with coinfection is very limited.
MATERIAL AND METHODS
We analyzed the evolution of renal recipients with HIV-HCV coinfection treated with direct-acting antivirals in our center. Clinical, analytical, and microbiological variables were collected before and after treatment.
RESULTS
From 2001 to 2018 we performed 11 renal transplants in patients with HIV infection, and 6 (54.5%) had HIV-HCV coinfection. One patient lost the graft before the development of direct-acting antivirals. Another patient with functioning graft has refused to receive any treatment. Four patients have been treated with direct-acting antivirals. One was treated 18 months before the transplant; 3 received treatment after transplant. All received sofosbuvir-based therapies. All had a sustained virologic response after 12 weeks and an improvement of liver function. In the patients treated after renal transplant, time post transplant at the beginning of treatment was 99.6 (SD, 22.8) months, and follow-up after treatment in all patients was 40.2 (SD, 8.16) months. To modify immunosuppressive regimen was not necessary, although 2 patients required an increase of tacrolimus doses. We do not observe deterioration of renal function. All have maintained a good immunologic and microbiological control without requiring changes in antiretrovirals. We do not observe complications associated with treatment.
CONCLUSIONS
Direct-acting antivirals therapy is safe and effective and may offer new possibilities to patients with HIV-HCV coinfection.
未标记
与仅感染人类免疫缺陷病毒（HIV）的肾移植受者相比，丙型肝炎病毒（HCV）和HIV合并感染的肾移植受者的移植物存活率和患者存活率较低。直接作用抗病毒药物的高疗效可能会改善结果。关于合并感染的肾移植受者的经验报道非常有限。
材料与方法
我们分析了在我们中心接受直接作用抗病毒药物治疗的HIV-HCV合并感染的肾移植受者的病情演变。收集治疗前后的临床、分析和微生物学变量。
结果
2001年至2018年，我们对11例HIV感染患者进行了肾移植，其中6例（54.5%）为HIV-HCV合并感染。1例患者在直接作用抗病毒药物出现之前失去了移植物。另1例移植物功能良好的患者拒绝接受任何治疗。4例患者接受了直接作用抗病毒药物治疗。1例在移植前18个月接受治疗；3例在移植后接受治疗。所有患者均接受了基于索磷布韦的治疗方案。所有患者在12周后均获得持续病毒学应答，肝功能得到改善。在肾移植后接受治疗的患者中，开始治疗时的移植后时间为99.6（标准差，22.8）个月，所有患者治疗后的随访时间为40.2（标准差，8.16）个月。虽然有2例患者需要增加他克莫司剂量，但无需调整免疫抑制方案。我们未观察到肾功能恶化。所有患者均保持良好的免疫和微生物学控制，无需改变抗逆转录病毒药物。我们未观察到与治疗相关的并发症。
结论
直接作用抗病毒药物治疗安全有效，可能为HIV-HCV合并感染的患者提供新的治疗选择。
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