Insights Into the Pathophysiology of Liver Disease in HCV/HIV: Does it End With HCV Cure?
Insights Into the Pathophysiology of Liver Disease in HCV/HIV: Does it End With HCV Cure?
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深入了解 HCV/HIV 肝病的病理生理学：HCV 治愈会结束吗？
DOI：
10.1093/infdis/jiaa279
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Chung,RaymondT
中科院分区：
文献类型：
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作者：
Jeyarajan,AndreJ;Chung,RaymondT
HCV- hiv合并感染患者相对于HCV单感染患者表现出肝损伤的快速进展。新的直接作用抗病毒药物的可用性极大地改善了合并感染患者的预后，因为持续的病毒学应答率现在超过95%，纤维化相关参数得到改善。然而，与HCV单感染患者相比，合并感染患者仍然具有更高的死亡风险和更严重的肝细胞癌，这意味着HIV感染者特有的途径的存在继续促进肝脏疾病的加速。本文综述了直接抗病毒时代HCV-HIV合并感染患者肝脏疾病的病理生物学，并探讨了HIV自身诱导肝损伤的机制。由于肝病是hiv阳性患者非艾滋病相关死亡的主要原因之一，因此加强我们对hiv相关纤维化途径的理解对于新的诊断和治疗策略仍然很重要，即使在HCV治愈后，也可以减缓或逆转肝病的进展。
HCV-HIV coinfected patients exhibit rapid progression of liver damage relative to HCV monoinfected patients. The availability of new directly acting antiviral agents has dramatically improved outcomes for coinfected patients as sustained virologic response rates now exceed 95% and fibrosis-related parameters are improved. Nevertheless, coinfected patients still have a higher mortality risk and more severe hepatocellular carcinoma compared to HCV monoinfected patients, implying the existence of pathways unique to people living with HIV that continue to promote accelerated liver disease. In this article, we review the pathobiology of liver disease in HCV-HIV coinfected patients in the directly acting antiviral era and explore the mechanisms through which HIV itself induces liver damage. Since liver disease is one of the leading causes of non-AIDS-related mortality in HIV-positive patients, enhancing our understanding of HIV-associated fibrotic pathways will remain important for new diagnostic and therapeutic strategies to slow or reverse liver disease progression, even after HCV cure.