直接作用抗病毒药物对慢性丙型肝炎感染中巨细胞病毒再激活的影响。
The Impact of Direct-Acting Antiviral Agents on Cytomegalovirus Reactivation in Chronic Hepatitis C Infection.
机构信息
Department of Microbial Biotechnology, Biotechnology Research Institute, National Research Centre, 33 EL Bohouth St., Dokki, Giza, Egypt.
Department of Tropical Medicine, Faculty of Medicine, Fayoum University, Egypt.
出版信息
Asian Pac J Cancer Prev. 2022 Apr 1;23(4):1365-1372. doi: 10.31557/APJCP.2022.23.4.1365.
OBJECTIVE
The co-infection of HCV/CMV may accelerate the progression of liver diseases and worsen responsiveness to IFN treatment. The Direct-acting antiviral agents (DAAs), currently approved therapy for HCV, may cause a transient change in immune status, favoring the reactivation of other viruses. The current study aims to evaluate the impact of DAAs treatment on the reactivation of latent CMV in HCV patients.
METHODS
The serological IgG, IgM Abs against CMV were detected by ELISA on192 HCV patients. The seronegative CMV IgM patients received (sofosbuvir/daclatasvir) regimen, then the CMV reactivation was examined by measuring the CMV IgM by ELISA and CMV DNA by real-time PCR.
RESULTS
The serological data revealed that all patients were positive for CMV IgG (100%) while (64%) patients were positive for CMV IgM. The seronegative CMV IgM (36%) received the DAAs protocol. The sustained virological response was monitored by measuring the HCV RNA viremia in the patient sera. The serological data revealed that 28.6% of patients had a reactivation of CMV, while 18.5% of patients had detectable CMV DNA viremia. Moreover, there was a significant improvement in liver function as well as a decrease in FIB-4 and APRI scores at EOT. SVR was reached 97.4% among the total studied patients (N= 192).
CONCLUSION
CMV co-infection has no impact on the response rate to DAAs. However, the CMV reactivation might have occurred after the complete eradication of HCV by DAAs.
目的
HCV/CMV 合并感染可能会加速肝脏疾病的进展，并降低 IFN 治疗的反应性。目前批准用于 HCV 的直接作用抗病毒药物（DAA）可能会导致免疫状态的短暂改变，有利于其他病毒的再激活。本研究旨在评估 DAA 治疗对 HCV 患者潜伏 CMV 再激活的影响。
方法
通过酶联免疫吸附试验（ELISA）检测 192 例 HCV 患者血清 IgG、IgM 抗 CMV 抗体。CMV IgM 阴性的 HCV 患者接受（索磷布韦/达卡他韦）方案治疗，然后通过 ELISA 法检测 CMV IgM，实时 PCR 法检测 CMV DNA，检查 CMV 再激活情况。
结果
血清学数据显示，所有患者 CMV IgG 均为阳性（100%），而 CMV IgM 阳性患者占（64%）。36%的 CMV IgM 阴性患者接受了 DAA 方案治疗。通过检测患者血清中 HCV RNA 病毒血症来监测持续病毒学应答。血清学数据显示，28.6%的患者发生了 CMV 再激活，18.5%的患者出现了可检测的 CMV DNA 病毒血症。此外，在 EOT 时肝功能明显改善，FIB-4 和 APRI 评分降低。192 例研究患者中，SVR 达到 97.4%。
结论
CMV 合并感染对 DAA 治疗的反应率没有影响。然而，CMV 可能在 HCV 被 DAA 完全清除后发生再激活。
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