愛滋感染者C型肝炎治療之新進展

Advance in the Treatment of HCV Infection in HIV-infected Patients

黃于珊(Yu-Shan Huang) ； 盛望徽(Wang-Huei Sheng)

《內科學誌》 31卷5期 (2020/10) Pp. 313-317

https://doi.org/10.6314/JIMT.202010_31(5).04

摘要

愛滋病毒（human immunodeficiency virus, HIV）感染者合併慢性C型肝炎感染有較高的風險發生肝硬化與肝代償不全。C型肝炎舊有的治療方法為長效干擾素合併雷巴威林，但在直接作用抗病毒藥物（direct-acting antiviral agent, DAA）問世後，已取代干擾素成為C型肝炎的治療首選。DAA用於C型肝炎治療有良好的耐受性與方便性，且DAA在HIV感染者與非HIV感染者的療效都同樣顯著，故所有合併HIV與C型肝炎病毒的感染者都應考慮接受DAA治療，並且進行C型肝炎的治療前評估如病毒基因型檢測、肝臟纖維化檢查。對HIV感染者而言，選用哪一種DAA之首要考量為與愛滋用藥間的藥物交互作用。開立DAA前應詳查病人的既有使用藥物，檢視是否需調整藥物種類或劑量，愛滋用藥中比較可能會與DAA互相影響的藥品為含ritonavir-或cobicistat等具有增效的蛋白酶抑制劑如darunavir/ritonavir或elvitegravir/cobicistat、某些非核苷酸反轉錄酶抑制劑如efavirenz或nevirapine以及tenofovirdisoproxil fumarate，使用這些抗愛滋藥物時需特別注意DAA的選用。給予DAA治療前也應檢驗患者的肝腎功能，以確認是否需調整劑量或避免使用。而在完成DAA治療後，仍應積極監測患者是否發生C型肝炎的再次感染。

關鍵字

C型肝炎（Hepatitis C） ； 人類免疫缺乏病毒（Human immunodeficiency virus） ； 愛滋病（Acquired Immunodeficiency Syndrome） ； 直接作用抗病毒藥物（Direct-acting antiviral agent） ； 藥物交互作用（Drug-drug interaction）

並列摘要

Patients with HIV/HCV (hepatitis C virus) coinfection have a greater risk of progression to cirrhosis or decompensated liver disease than patients with HCV mono-infection. For HIV/HCV-coinfected patients, direct-acting antiviral (DAA) HCV regimen is well tolerated, and DAA therapy can achieve sustained HCV virologic response at rates comparable to those in patients with HCV mono-infection. All HIV/HCV-coinfected patients should be evaluated for HCV therapy, and the evaluation should include screening for active and prior hepatitis B virus infection, assessing their HCV genotype and liver fibrosis stage. Several antiretroviral (ARV) agents and DAAs have the potential for clinically significant pharmacokinetic drug-drug interactions when used in combination. If both HIV and HCV treatments are indicated, the DAA regimen should be selected with careful consideration of drug-drug interactions to the ARV regimen. ARV agents which should be used cautiously include protease inhibitors, non-nucleoside reverse transcriptase inhibitors (NNRTIs), and tenofovir disoproxil fumarate (TDF). In summary, HIV/HCV-coinfected patients should be treated and retreated the same as patients without HIV infection, after recognizing and managing interactions with antiretroviral medications.