Treatment of chronic hepatitis C in patients with HIV/HCV coinfection

作     者：Nicola Coppola Salvatore Martini Mariantonietta Pisaturo Caterina Sagnelli Pietro Filippini Evangelista Sagnelli 

作者机构：Department of Mental Health and Public MedicineSection of Infectious DiseasesSecond University of Naples Division of Infectious DiseasesAORN Sant’Anna e San Sebastiano di Caserta Department of Clinical and Experimental Medicine and Surgery "F.Magrassi e A.Lanzara"Second University of Naples 

出 版 物：《World Journal of Virology》 (世界病毒学杂志)

年 卷 期：2015年第4卷第1期

页      面：1-12页

学科分类：10[医学] 

主　　题：Hepatitis C virus infection Human immunodeficiency virus infection Anti-hepatitis C virus treatment Directly acting antivirals HIV/HCV coinfection Chronic hepatitis C 

摘      要：Hepatitis C virus(HCV) infection is one of the mostfrequent causes of comorbidity and mortality in the human immunodeficiency virus(HIV) population, and liver-related mortality is now the second highest cause of death in HIV-positive patients, so HCV infection should be countered with adequate antiviral therapy. In 2011 began the era of directly acting antivirals(DAAs) and the HCV NS3/4A protease inhibitors telaprevir and boceprevir were approved to treat HCV-genotype-1 infection, each one in combination with pegylated interferon alfa(Peg-IFN) + ribavirin(RBV). The addition of the first generation DAAs, strongly improved the efficacy of antiviral therapy in patients with HCVgenotype 1, both for the HCV-monoinfected and HIV/HCV coinfected, and the poor response to Peg-IFN + RBV in HCV/HIV coinfection was enhanced. These treatments showed higher rates of sustained virological response than Peg-IFN + RBV but reduced tolerability and adherence due to the high pill burden and the several pharmacokinetic interactions between HCV NS3/4A protease inhibitors and antiretroviral drugs. Then in 2013 a new wave of DAAs arrived, characterized by high efficacy, good tolerability, a low pill burden and shortened treatment duration. The second and third generation DAAs also comprised IFN-free regimens, which in small recent trials on HIV-positive patients have shown comforting preliminary results in terms of efficacy, tolerability and adherence.