HCV and HIV co-infection: mechanisms and management.
HCV and HIV co-infection: mechanisms and management.
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DOI：
10.1038/nrgastro.2014.17
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发表时间：
2014-06
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--
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与HCV单一感染相比，HCV和HIV合并感染与加速的肝纤维化进展和更高的肝脏失代偿和死亡率相关，并且肝脏疾病是HIV感染患者中非AIDS相关死亡的主要原因。新的见解揭示了HCV和HIV加速疾病进展的多种机制，特别是HIV感染增加HCV复制，增强HCV诱导的肝脏炎症，增加肝细胞凋亡，增加肠道微生物易位，并导致HCV特异性免疫反应受损。抗逆转录病毒疗法治疗HIV和HCV治疗已被独立证明可延缓纤维化的进展，并减少合并感染患者中终末期肝病的并发症。然而，与HCV单一感染患者相比，PEG-IFN和利巴韦林的持续病毒学应答率在合并感染患者中显著较差，并且鉴于目前HCV方案的有限疗效和耐受性，治疗吸收仍然较低。随着多种直接作用的抗病毒药物治疗HCV的开发，存在一个独特的机会来重新定义合并感染患者的治疗模式，其中包括纤维化阶段的数据以及与抗逆转录病毒治疗的潜在药物相互作用。
HCV and HIV co-infection is associated with accelerated hepatic fibrosis progression and higher rates of liver decompensation and death compared to HCV monoinfection, and liver disease is a leading cause of non-AIDS related mortality among HIV-infected patients. New insights have revealed multiple mechanisms by which HCV and HIV lead to accelerated disease progression, specifically that HIV infection increases HCV replication, augments HCV-induced hepatic inflammation, increases hepatocyte apoptosis, increases microbial translocation from the gut, and leads to an impairment of HCV-specific immune responses. Treatment of HIV with antiretroviral therapy and treatment of HCV have independently been shown to delay the progression of fibrosis and reduce complications from end-stage liver disease among co-infected patients. However, rates of sustained virologic response with PEG-IFN and ribavirin have been significantly inferior among co-infected patients compared to HCV monoinfected patients, and treatment uptake has remained low given the limited efficacy and tolerability of current HCV regimens. With multiple direct acting antivirals in development to treat HCV, a unique opportunity exists to redefine the treatment paradigm for co-infected patients, which incorporates data on fibrosis stage as well as potential drug interactions with antiretroviral therapy.
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