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HIV感染者中丙型肝炎的流行病学、自然病程与诊断

Author
Arthur Y Kim, MD, FIDSA
Section Editor
David L Thomas, MD
Deputy Editor
Allyson Bloom, MD
Translators
郭传勇, 主任医师，教授

引言

人类免疫缺陷病毒(human immunodeficiency virus, HIV)和丙型肝炎病毒(hepatitis C virus, HCV)的交叉感染流行具有重要的临床意义，为患者及其医疗保健提供者带来了许多挑战[1]。全面了解此类复杂患者群体中肝病的自然病程，对于制定最佳的治疗方式十分重要。

本文将讨论HIV感染者中丙型肝炎的流行病学、自然病程及诊断。 (参见“慢性丙型肝炎病毒感染的HIV感染者的评估”和“艾滋病病毒感染者丙型肝炎病毒感染的治疗”)

HCV的病毒学

病毒动力学 — HIV(一种逆转录病毒)和HCV(一种黄病毒)均为RNA病毒，已通过对病毒生成与强效抗病毒药物对病毒的清除之间稳态的扰动分析，测定了HIV和HCV的病毒动力学[2,3]。HIV的病毒生成速率约为一日1010个病毒体，半衰期短于6小时[2]；而HCV的病毒生成速率则更高，约为一日1012个病毒体，半衰期为2.7小时[3]。

病毒载量 — 在HIV或HCV感染的慢性阶段，维持着一个相对稳定的病毒载量或“调定点(set point)”[4,5]。然而，相比于单纯感染HCV的患者，在合并感染时，HCV RNA水平会在HIV血清转化后增加，且随着时间的推移而持续上升[6,7]。在大多数(但并非所有)研究中，HCV病毒血症的水平与较低的CD4细胞计数呈负相关[7,8]，在开始抗逆转录病毒治疗(antiretroviral therapy, ART)或过度饮酒时，HCV病毒血症的水平可能会短暂升高[9]。HCV病毒载量的整体增高对肝脏相关疾病的严重程度并无影响，但对治疗反应有影响。 (参见“慢性丙型肝炎病毒感染的HIV感染者的评估”)

一项研究评估了HIV感染者中较高水平的HCV病毒血症是否可能与免疫抑制相关[10]。研究人员推断，如果高水平的病毒复制是由免疫选择压力降低造成的，那么可以预计该病毒自身的核苷酸变化发生率会降低。然而，在一项检查了79例患者(伴或不伴HIV共感染)的HCV包膜序列的研究中，随着时间推移并未发现两组间存在显著的差异。HIV感染增加HCV复制的另一种可能方式是通过HIV病毒本身；一项体外研究表明，HIV的包膜蛋白(gp120)通过结合HIV的细胞辅助受体(即CXCR4或CCR5)来增加HCV的复制[11]。

                              

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-13.
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