Impact and Management of hepatitis B and hepatitis C virus co-infection in HIV patients

摘要: Individuals at risk of HIV are concomitantly acquiring parenterally or sexually transmitted viruses, including HBV and HCV. After the introduction highly active antiretroviral therapy (ART), liver disease has emerged as a major cause morbidity mortality in HIV-infected persons. HBV, HCV share common routes transmission, but differential efficiency these viruses to types exposures underlies difference their prevalence by geographic region. Coinfection alters natural history each peculiar way; furthermore coinfection with viral hepatitis may complicate delivery ART increasing drug-related hepatoxicity impacting selection specific agents (e.g., those dually against HBV). The treatment co-infection is complex because drug(s) used is/are associated drug-resistance, cross-resistance, hepatotoxicity suboptimal response. aim achieve long-term sustained (HBV) suppression. should be treated coinfected patients elevated DNA significant hepatic fibrosis (Metavir score = A2 F2). threshold for initiation lower than monoinfection. Anti also considered receiving irrespective load fibrosis, order prevent immune reconstitution. Selection depends on whether require only both HIV. In requiring treatment, drugs dual antiviral activity not avoid early resistance. When meet criteria included anti-retroviral regimen. Treatment monitored measuring ALT levels 3 6 monthly. required duration induviduals known possibly life long. Every person compensated chronic treatment. However, avoided decompensated cirrhosis presence opportunistic infection. CD4 counts <200 cells/il and/or plasma HIV-RNA above 100,000 copies/mI, it better consider anti before standard pegylated interferon alfa-2a (Pegasys) -2b (Peg-Intron) plus ribavirin 48 weeks. Several studies have shown an overall vwal response rate 14% 29% genotype 1 53% 73% genotypes 2 3. other concern drug interaction retroviral necessitating avoidance certain from persons denied HAART evaluated transplantation. Finally, management responding standared known.