Soriano Vicente, Moreno-Torres Víctor, Treviño Ana, Barreiro Pablo, de Jesus Fernando, Corral Octavio, de Mendoza Carmen
Health Sciences School & Medical Center, Universidad Internacional La Rioja (UNIR), Madrid, Spain.
Department of Internal Medicine, Puerta de Hierro University Hospital & Research Institute, Majadahonda, Madrid, Spain.
Expert Opin Drug Saf. 2023 Jan-Jun;22(5):363-372. doi: 10.1080/14740338.2023.2206647. Epub 2023 Apr 27.
Both HCV and HIV are highly prevalent infections with current estimates of 57 and 38 million people infected worldwide, respectively. Oral antivirals can be curative for HCV and rescue HIV patients from disease progression. Dual therapy in coinfected patients requires expertise.
Four major issues challenge dual HCV and HIV treatment, including overlapping drug-related side effects, hepatitis B reactivation, immune reconstitution inflammatory syndromes (IRIS), and drug-drug interactions (DDI). A search was conducted in PubMed from January 2010 to March 2023.
The advent of second-generation direct-acting antivirals (DDA) that depict higher antiviral potency, fewer side effects, pangenotypic activity and are co-formulated has expanded the indication of HCV therapy and particularly in HIV-coinfected individuals. Sequential initiation of antiretrovirals (ARV) followed by DAA is generally preferred to start dual treatment concomitantly. Close monitoring of rare episodes of HBV reactivation and IRIS is warranted. The most frequent DDI between DAA and ARV affect drug metabolism by CYP450 induction/inhibition, leading to abnormal drug exposures. Throughout this mechanism interact most HCV and HIV protease inhibitors and non-nucleoside polymerase inhibitors. Exposure to some HIV and HCV nucleos(t)ide analogues (e.g. tenofovir and sofosbuvir, respectively) is subject to induction/inhibition of drug transporters and requires special attention in patients with renal insufficiency.
丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）感染都极为普遍，目前全球估计分别有5700万和3800万人感染。口服抗病毒药物可治愈HCV，并使HIV患者免于疾病进展。合并感染患者的双重治疗需要专业知识。
HCV和HIV双重治疗面临四个主要问题，包括重叠的药物相关副作用、乙型肝炎病毒再激活、免疫重建炎症综合征（IRIS）和药物相互作用（DDI）。于2010年1月至2023年3月在PubMed上进行了检索。
第二代直接作用抗病毒药物（DAA）的出现，其具有更高的抗病毒效力、更少的副作用、泛基因型活性且为复方制剂形式，扩大了HCV治疗的适应症，尤其是在合并HIV感染的个体中。通常更倾向于先序贯启动抗逆转录病毒药物（ARV），然后再使用DAA开始双重治疗，而非同时开始。有必要密切监测罕见的HBV再激活和IRIS事件。DAA与ARV之间最常见的DDI通过细胞色素P450诱导/抑制影响药物代谢，导致药物暴露异常。大多数HCV和HIV蛋白酶抑制剂以及非核苷聚合酶抑制剂通过这种机制相互作用。某些HIV和HCV核苷（酸）类似物（例如分别为替诺福韦和索磷布韦）的暴露会受到药物转运体的诱导/抑制，肾功能不全患者需要特别关注。
