Ramos Paesa C, Pascual Catalán A, Arazo Garcés P, Aguirre Errasti J M, Lasierra P
Servicio de Medicina Interna, Hospital Miguel Servet, Zaragoza.
Rev Clin Esp. 1998 Apr;198(4):212-6.
To know the prevalence of viral genotype in patients infected with hepatitis C virus (HCV) and coinfected with HIV and evaluate its clinical implications.
The genotype of the HVC was studied (INNO-LiPA HCV II, Imnogenetics, Belgium) in 40 patients coinfected with HIV; from 28 of these patients histologic data of chronic hepatitis were available. The most prevalent genotype was analyzed in this type of patients and its associations with different issues: risk behavior, histologic activity of liver disease and viremia level (quantitative PCR, Amplicor HCV, Roche Diagnostics).
Genotype 1 was the most prevalent (55%), and subtype 1a predominated (36.3%). In most cases genotypes 1a and 3 were found (65%) and in four cases (10%) there was coinfection with two genotypes. The most common risk behavior was parenteral drug use (PDU) (34 cases), which might account for the higher prevalence of genotypes 1 and 3. A mild hepatic histologic activity was most frequently associated with genotype 3 compared with genotype 1 (63.6% versus 46.6%). The Knodell histologic activity index (HAI) was higher in the four patients with coinfection 1 + 3 versus the remaining patients (11.2 +/- 2.8 versus 7.8 +/- 3.6). The percentage of patients with genotype 1 with a viral load > 10(5) was higher than that of patients with genotype 3 (80% versus 7.6% [4]) (p < 0.05); in the two cases with subtype 1b viremia levels exceeded this limit.
The prevalent HCV genotypes in patients coinfected with HIV in our environment seem to be 1a and 3, which is probably associated with the more common high risk behavior of PDU among these patients. Genotype 3 seems to be associated with a milder histologic liver damage and a lower viral load, and these two characteristics might be related. The HCV genotype should be considered in subjects coinfected with HIV to obtain a better clinical and prognostic evaluation of the chronic liver disease it causes.
了解丙型肝炎病毒（HCV）感染合并人类免疫缺陷病毒（HIV）感染患者的病毒基因型流行情况，并评估其临床意义。
采用INNO-LiPA HCV II（比利时Imnogenetics公司）对40例HIV合并感染患者的HCV基因型进行研究；其中28例患者有慢性肝炎的组织学数据。分析此类患者中最常见的基因型及其与不同问题的关联：危险行为、肝脏疾病的组织学活性和病毒血症水平（定量PCR，Amplicor HCV，罗氏诊断公司）。
基因型1最为常见（55%），其中1a亚型占主导（36.3%）。多数病例中发现基因型1a和3（65%），4例（10%）为两种基因型合并感染。最常见的危险行为是注射吸毒（PDU）（34例），这可能是基因型1和3患病率较高的原因。与基因型1相比，基因型3最常与轻度肝脏组织学活性相关（63.6%对46.6%）。1 + 3合并感染的4例患者的Knodell组织学活性指数（HAI）高于其余患者（11.2±2.8对7.8±3.6）。病毒载量>10⁵的基因型1患者百分比高于基因型3患者（80%对7.6%[4]）（p<0.05）；在2例1b亚型病例中，病毒血症水平超过此限。
在我们的环境中，HIV合并感染患者中流行的HCV基因型似乎是1a和3，这可能与这些患者中更常见的注射吸毒高风险行为有关。基因型3似乎与较轻的肝脏组织学损伤和较低的病毒载量相关，这两个特征可能有关联。对于HIV合并感染患者，应考虑HCV基因型，以便对其所导致的慢性肝病进行更好的临床和预后评估。
