John M, Flexman J, French M A
Department of Clinical Immunology, Royal Perth Hospital, Western Australia, Australia.
AIDS. 1998 Dec 3;12(17):2289-93. doi: 10.1097/00002030-199817000-00010.
To report observations from case studies on the pathogenic mechanisms underlying the acute hepatitis that sometimes occurs in hepatitis C virus (HCV) and HIV coinfected patients following treatment with potent antiretroviral therapy that includes a HIV protease inhibitor.
Cases of acute hepatitis were identified from a group of 133 patients enrolled in a retrospective study of pathogen-associated inflammatory disease following the use of potent antiretroviral therapy. Data on serum alanine aminotransferase concentrations, clinical events, HCV antibodies, and liver biopsies were collected from medical records. HCV RNA assays and additional HCV antibody assays were undertaken on stored plasma or sera.
Three of the 133 patients (2%) developed symptomatic hepatitis. One was HCV antibody-positive prior to commencing antiretroviral therapy and developed hepatitis subsequent to an episode of Mycobacterium avium complex disease associated with immune restoration. However, the other two patients had previously undiagnosed HCV infection for up to 2 years prior to antiretroviral therapy, with HCV RNA detected but anti-HCV antibody repeatedly undetectable in stored plasma or sera. HCV antibody was only detectable after antiretroviral therapy-induced decrease in plasma HIV RNA and immunological reconstitution. Plasma HCV RNA increased after therapy in one of these patients, but in the other the level was not increased at a time of active hepatitis demonstrated by liver biopsy.
Hepatitis in HCV-HIV-coinfected patients following treatment with potent antiretroviral therapy may reflect restoration of anti-HCV immune responses rather than increased HCV replication or a hepatotoxic effect of antiretroviral therapy.
报告关于丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）合并感染患者在接受包括HIV蛋白酶抑制剂的强效抗逆转录病毒治疗后有时会发生的急性肝炎潜在致病机制的病例研究观察结果。
从一组133名患者中识别出急性肝炎病例，这些患者参与了一项关于使用强效抗逆转录病毒治疗后病原体相关炎症性疾病的回顾性研究。从病历中收集血清丙氨酸氨基转移酶浓度、临床事件、HCV抗体和肝活检的数据。对储存的血浆或血清进行HCV RNA检测和额外的HCV抗体检测。
133名患者中有3名（2%）发生了有症状的肝炎。1名患者在开始抗逆转录病毒治疗前HCV抗体呈阳性，在与免疫重建相关的鸟分枝杆菌复合群疾病发作后发生了肝炎。然而，另外2名患者在抗逆转录病毒治疗前长达2年一直未被诊断出HCV感染，储存的血浆或血清中检测到HCV RNA，但反复检测不到抗HCV抗体。仅在抗逆转录病毒治疗导致血浆HIV RNA下降和免疫重建后，HCV抗体才检测得到。其中1名患者治疗后血浆HCV RNA增加，但另1名患者在肝活检显示有活动性肝炎时其水平未升高。
HCV-HIV合并感染患者在接受强效抗逆转录病毒治疗后发生的肝炎可能反映了抗HCV免疫反应的恢复，而非HCV复制增加或抗逆转录病毒治疗的肝毒性作用。
