UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

慢性丙型肝炎病毒感染的HIV感染者的评估

Author
Arthur Y Kim, MD, FIDSA
Section Editor
David L Thomas, MD
Deputy Editor
Allyson Bloom, MD
Translators
张琳, 教授

引言

随着高效抗逆转录病毒治疗(antiretroviral therapy, ART)的引入，在人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者中，机会性感染导致的死亡率下降，而由终末期肝病引起的并发症发生率和死亡率增加。这些临床观察结果为慢性丙型肝炎病毒(hepatitis C virus, HCV)感染的HIV感染者的评估和治疗提供了充分的理由。

HIV/HCV共感染者在整个治疗期间可获益于多学科团队协作方案和强化支持治疗。在此患者人群中丙型肝炎处理的复杂性将总结在此。HIV感染者中HCV感染的流行病学、自然病程、诊断和治疗将在别处讨论。 (参见“HIV感染者中丙型肝炎的流行病学、自然病程与诊断”和“艾滋病病毒感染者丙型肝炎病毒感染的治疗”)

初始评估

病史 — 对于为了进行丙型肝炎评估和可能的治疗而就诊的HIV感染者，应该进行全面的病史采集和体格检查。

物质滥用 — 对于有物质滥用史且目前正在戒毒的患者，应询问其戒毒的稳定性，因为干扰素治疗与复吸有关[1]。对于正在注射吸毒的人群，也不排除治疗的可能性；决定治疗与否应取决于患者对药物治疗的依从性、是否能够返回医院接受随访，以及能否避免再感染(例如，避免共用针头)[2,3]。对于吸毒者，采用美沙酮或丁丙诺啡等药物治疗成瘾能有效地促进HCV感染的治疗。 (参见“艾滋病病毒感染者丙型肝炎病毒感染的治疗”)

还应详细询问酒精使用情况；应嘱共感染者摄入酒精，因为酒精与HCV感染者的疾病进展加速有关[4]。此外，在患者戒酒后，CD4计数可能升高[5]。 (参见“HIV感染者中丙型肝炎的流行病学、自然病程与诊断”)

                           

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2016-04-12.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Zdilar D, Franco-Bronson K, Buchler N, et al. Hepatitis C, interferon alfa, and depression. Hepatology 2000; 31:1207.
  2. Sylvestre D. Hepatitis C treatment in drug users: perception versus evidence. Eur J Gastroenterol Hepatol 2006; 18:129.
  3. Taylor LE, Gholam PM, Schwartzapfel B, Rich JD. Hepatitis C treatment in an HIV-HCV-coinfected patient with drug addiction and psychiatric illness: a case report. AIDS Read 2005; 15:629.
  4. Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet 1997; 349:825.
  5. Pol S, Artru P, Thépot V, et al. Improvement of the CD4 cell count after alcohol withdrawal in HIV-positive alcoholic patients. AIDS 1996; 10:1293.
  6. Schaefer M, Heinz A, Backmund M. Treatment of chronic hepatitis C in patients with drug dependence: time to change the rules? Addiction 2004; 99:1167.
  7. Farel C, Suzman DL, McLaughlin M, et al. Serious ophthalmic pathology compromising vision in HCV/HIV co-infected patients treated with peginterferon alpha-2b and ribavirin. AIDS 2004; 18:1805.
  8. Wong SF, Jakowatz JG, Taheri R. Management of hypertriglyceridemia in patients receiving interferon for malignant melanoma. Ann Pharmacother 2004; 38:1655.
  9. Rallón NI, Naggie S, Benito JM, et al. Association of a single nucleotide polymorphism near the interleukin-28B gene with response to hepatitis C therapy in HIV/hepatitis C virus-coinfected patients. AIDS 2010; 24:F23.
  10. Pineda JA, Caruz A, Rivero A, et al. Prediction of response to pegylated interferon plus ribavirin by IL28B gene variation in patients coinfected with HIV and hepatitis C virus. Clin Infect Dis 2010; 51:788.
  11. Pérez-Elías MJ, García-San Miguel L, González García J, et al. Tuberculosis complicating hepatitis C treatment in HIV-infected patients. Clin Infect Dis 2009; 48:e82.
  12. Uberti-Foppa C, De Bona A, Galli L, et al. Liver fibrosis in HIV-positive patients with hepatitis C virus: role of persistently normal alanine aminotransferase levels. J Acquir Immune Defic Syndr 2006; 41:63.
  13. Saadeh S, Cammell G, Carey WD, et al. The role of liver biopsy in chronic hepatitis C. Hepatology 2001; 33:196.
  14. Yano M, Kumada H, Kage M, et al. The long-term pathological evolution of chronic hepatitis C. Hepatology 1996; 23:1334.
  15. McGovern B, Fiore J, Wurcel A, et al. Delivering therapy for hepatitis C virus infection to incarcerated HIV-seropositive patients. Clin Infect Dis 2005; 41 Suppl 1:S56.
  16. McGovern BH. Hepatitis C in the HIV-infected patient. J Acquir Immune Defic Syndr 2007; 45 Suppl 2:S47.
  17. Veronese L, Rautaureau J, Sadler BM, et al. Single-dose pharmacokinetics of amprenavir, a human immunodeficiency virus type 1 protease inhibitor, in subjects with normal or impaired hepatic function. Antimicrob Agents Chemother 2000; 44:821.
  18. Brinkman K, Smeitink JA, Romijn JA, Reiss P. Mitochondrial toxicity induced by nucleoside-analogue reverse-transcriptase inhibitors is a key factor in the pathogenesis of antiretroviral-therapy-related lipodystrophy. Lancet 1999; 354:1112.
  19. Duong Van Huyen JP, Landau A, Piketty C, et al. Toxic effects of nucleoside reverse transcriptase inhibitors on the liver. Value of electron microscopy analysis for the diagnosis of mitochondrial cytopathy. Am J Clin Pathol 2003; 119:546.
  20. McGovern BH, Ditelberg JS, Taylor LE, et al. Hepatic steatosis is associated with fibrosis, nucleoside analogue use, and hepatitis C virus genotype 3 infection in HIV-seropositive patients. Clin Infect Dis 2006; 43:365.
  21. Soriano V, Miró JM, García-Samaniego J, et al. Consensus conference on chronic viral hepatitis and HIV infection: updated Spanish recommendations. J Viral Hepat 2004; 11:2.
  22. Sulkowski, M, Mehta, S, Torbenson, M, et al. Unexpected significant liver disease among HIV/HCV coinfected patients with minimal fibrosis on initial liver biopsy. Presented at the 11th Conference on Retroviruses and Opportunistic Infections, Boston, MA, February, 2005; abstract #121.
  23. Nunes D, Fleming C, Offner G, et al. HIV infection does not affect the performance of noninvasive markers of fibrosis for the diagnosis of hepatitis C virus-related liver disease. J Acquir Immune Defic Syndr 2005; 40:538.
  24. Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology 2006; 43:1317.
  25. Shire NJ, Rao MB, Succop P, et al. Improving noninvasive methods of assessing liver fibrosis in patients with hepatitis C virus/human immunodeficiency virus co-infection. Clin Gastroenterol Hepatol 2009; 7:471.
  26. Sandrin L, Fourquet B, Hasquenoph JM, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003; 29:1705.
  27. de Lédinghen V, Douvin C, Kettaneh A, et al. Diagnosis of hepatic fibrosis and cirrhosis by transient elastography in HIV/hepatitis C virus-coinfected patients. J Acquir Immune Defic Syndr 2006; 41:175.
  28. Vergara S, Macías J, Rivero A, et al. The use of transient elastometry for assessing liver fibrosis in patients with HIV and hepatitis C virus coinfection. Clin Infect Dis 2007; 45:969.
  29. Kirk GD, Astemborski J, Mehta SH, et al. Assessment of liver fibrosis by transient elastography in persons with hepatitis C virus infection or HIV-hepatitis C virus coinfection. Clin Infect Dis 2009; 48:963.
  30. Castera L. Transient elastography and other noninvasive tests to assess hepatic fibrosis in patients with viral hepatitis. J Viral Hepat 2009; 16:300.
  31. Puoti M, Bruno R, Soriano V, et al. Hepatocellular carcinoma in HIV-infected patients: epidemiological features, clinical presentation and outcome. AIDS 2004; 18:2285.
  32. Bräu N, Fox RK, Xiao P, et al. Presentation and outcome of hepatocellular carcinoma in HIV-infected patients: a U.S.-Canadian multicenter study. J Hepatol 2007; 47:527.
  33. Salmon-Ceron, D. J Hepatology 2009; 50:739.