Hepatitis C in the HIV-infected patient

被引:26
作者
McGovern, Barbara H. [1 ]
机构
[1] Lemuel Shattuck Hosp, Div Infect Dis, Boston, MA 02130 USA
关键词
hepatitis C; hepatitis C treatment; HIV; HIV/hepatitis C virus coinfection; HUMAN-IMMUNODEFICIENCY-VIRUS; INTERFERON-ALPHA-2B PLUS RIBAVIRIN; INJECTION-DRUG USERS; STAGE LIVER-DISEASE; COINFECTED PATIENTS; PEGINTERFERON ALPHA-2B; PEGYLATED INTERFERON-ALPHA-2B; ANTIRETROVIRAL THERAPY; FIBROSIS PROGRESSION; VIROLOGICAL RESPONSE;
D O I
10.1097/QAI.0b013e318068d190
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Hepatitis C virus (HCV) coinfection in the presence of HIV raises several challenging issues for the treating clinician. Some evidence indicates that concomitant HIV infection alters HCV virology in ways that are relevant for treatment. Pegylated interferon plus ribavirin is the recommended therapy for HCV in HIV-infected patients. Proportionately fewer HIV/HCV-coinfected patients achieve a sustained virologic response (SVR) compared with those infected with HCV alone. Possible reasons for this include higher levels of HCV viremia and inadequate ribavirin exposure. Strategies under study for optimizing therapeutic response include weight-based ribavirin dosing, use of growth factors to avoid dose reduction, and longer duration of therapy. Aggressive management of adverse effects to avoid dose reduction or treatment discontinuation is also crucial. An integrated multidisciplinary team, including a psychiatrist and addictions specialist, can increase the proportion of HIV/HCV-coinfected patients eligible for treatment. Investigational options exist for patients who relapse after treatment is discontinued and for those with a partial virologic response. Promising therapies that are under development include protease and polymerase inhibitors.
引用
收藏
页码:S47 / S56
页数:10
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