HIV- und Hepatitis-C-Koinfektion

Zusammenfassung

Die HCV-Koinfektion ist mittlerweile eine der klinisch relevantesten Begleiterkrankungen HIV-infizierter Menschen und nach AIDS die häufigste Todesursache bei HIV/HCV-Koinfektion. Europaweit sind gut ein Drittel aller HIV-Patienten HCV-koinfiziert. Der natürliche Verlauf der Hepatitis-C-Infektion ist im Rahmen einer HIV-Koinfektion, insbesondere bei fortgeschrittenem Immundefekt, deutlich beschleunigt, so dass HIV/HCV-koinfizierte Patienten früher die Folgen einer fortgeschrittenen Leberfibrose und -zirrhose erleben als HCV-monoinfizierte Patienten. Eine Immunrekonstitution im Rahmen einer hochaktiven antiretroviralen Therapie (HAART) mit Wiederanstieg der CD4-Helferzellen war dabei in verschiedenen Studien mit einer Verlangsamung der Fibroseprogression assoziiert, so dass ein früher Beginn der HAART bei HCV-Koinfektion empfohlen wird. Darüber hinaus kann ein Voranschreiten der Fibrose und somit das Entstehen einer Leberzirrhose mit entsprechenden Komplikationen durch eine erfolgreiche Behandlung der Hepatitis C verhindert werden. Daher sollte jeder HIV/HCV Koinfizierte hinsichtlich einer Kombinationstherapie mit pegyliertem Interferon und Ribavirin evaluiert werden. – In der Übersicht stellen wir die aktuellen Daten zur Epidemiologie, dem natürlichen Verlauf und die Leitlinien zur Behandlung der HIV/HCV Koinfektion vor.

Abstract

Chronic hepatitis C virus (HCV) infection is currently one of the most clinically relevant co-morbidities in the HIV-infected population. Overall, one third of HIV-infected individuals in Europe are HCV co-infected. The progression of chronic HCV infection to liver cirrhosis with subsequent risk for liver decompensation and hepatocellular carcinoma is substantially accelerated in HIV/HCV co-infected compared to HCV mono-infected individuals, particularly with advanced levels of immunodeficiency. Indeed, immune reconstitution under HAART has been associated with slowing down fibrosis progression in HIV/HCV co-infected individuals. Therefore HAART initiation is recommended earlier in HCV co-infected patients. Moreover, the sequelae of chronic hepatitis C infection can be stopped by successful treatment with pegylated interferon and ribavirin combination therapy so that every HIV/HCV co-infected patient should be evaluated for possible HCV treatment. – In this review we summarize the current epidemiology, natural course of HCV in HIV co-infection and current guidelines for management of chronic hepatitis C infection in HIV co-infected patients.

Schlüsselwörter

HIV-Infektion - Hepatitis C - Diagnostik - Interferon - Ribavirin - hochaktive antiretrovirale Therapie (HAART)

Keywords

HIV infection - hepatitis C - diagnosis - interferon - ribavirin - highly active antiretroviral therapy (HAART)

Literatur

• 1 Anonymus: The future of harm reduction programmes in Russia.  Lancet. 2009;  374 1213
• 2 Bani-Sadr F, Carrat F, Pol S. et al . Risk factors for symptomatic mitochondrial toxicity in HIV/hepatitis C virus-coinfected patients during interferon plus ribavirin-based therapy.  J Acquir Immune Defic Syndr. 2005;  40 47-52
• 3 Bani-Sadr F, Denoeud L. et al . Early virologic failure in HIV-coinfected hepatitis C patients treated with the peginterferon-ribavirin combination: does abacavir play a role?.  J Acquir Immune Defic Syndr. 2007;  45 123-125
• 4 Benhamou Y, Bochet M, Di Martino V. et al . Liver fibrosis progression in human immunodeficiency virus and hepatitis C virus coinfected patients. The Multivirc Group.  Hepatology. 1999;  30 1054-1058
• 5 Berenguer J, Alvarez-Pellicer J, Martin P M. et al . Sustained virological response to interferon plus ribavirin reduces liver-related complications and mortality in patients coinfected with human immunodeficiency virus and hepatitis C virus.  Hepatology. 2009;  50 407-413
• 6 Cai W, Radun D. Fachgebiet 34 des Robert Koch Instituts .Virushepatitis B, C und D im Jahr 2008. Epidemiologisches Bulletin Nr. 20 vom 18.5.2009. 
• 7 Danta M, Semmo N, Fabris P. et al . Impact of HIV on host-virus interactions during early hepatitis C virus infection.  J Infect Dis. 2008;  197 1558-1566
• 8 Frederick T, Burian P, Terrault N. et al . Factors associated with prevalent hepatitis C infection among HIV-infected women with no reported history of injection drug use.  AIDS Patient Care STDS. 2009;  23 915-923
• 9 Giraudon I, Ruf M, Maguire H. et al . Increase in diagnosed newly acquired hepatitis C in HIV-positive men who have sex with men across London and Brighton, 2002 – 2006.  Sex Transm Infect. 2008;  84 111-115
• 10 Jones L, Uriel A, Kaplan D. et al .Natural History and Treatment Outcome of Acute hepatitis C With and Without HIV Co-infection in a North American Cohort. In, AASLD 2008 Meeting. San Francisco, USA; 2008 , Abstract 1838
• 11 Kempf D J, Klein C, Chen H J. et al . Pharmacokinetic enhancement of the hepatitis C virus protease inhibitors VX-950 and SCH 503 034 by co-dosing with ritonavir.  Antivir Chem Chemother. 2007;  18 163-167
• 12 Laufer N, Laguno M, Perez I. et al . Abacavir does not influence the rate of virological response in HIV-HCV-coinfected patients treated with pegylated interferon and weight-adjusted ribavirin.  Antivir Ther. 2008;  13 953-957
• 13 Martin-Carbonero L, Benhamou Y, Puoti M. et al . Incidence and predictors of severe liver fibrosis in human immunodeficiency virus-infected patients with chronic hepatitis C.  Clin Infect Dis. 2004;  38 128-133
• 14 Martin-Carbonero L, Nunez M, Marino A. et al . Undetectable hepatitis C virus RNA at week 4 as predictor of sustained virological response in HIV patients with chronic hepatitis C.  AIDS. 2008;  22 15-21
• 15 Mira J A, Lopez-Cortes L F, Barreiro P. et al . Efficacy of pegylated interferon plus ribavirin treatment in HIV/hepatitis C virus co-infected patients receiving abacavir plus lamivudine or tenofovir plus either lamivudine or emtricitabine as nucleoside analogue backbone.  J Antimicrob Chemother. 2008;  62 1365-1373
• 16 Moreno S, Garcia-Samaniego J, Moreno A. et al . Noninvasive diagnosis of liver fibrosis in patients with HIV infection and HCV/HBV co-infection.  J Viral Hepat. 2009;  16 249-258
• 17 Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines on the use of antiretroviral agents in HIV-1 infected adults and adolescents. Department of Health and Human Services: December 1, 2009; 2001 – 2161. http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf
• 18 Pineda J A, Garcia-Garcia J A, Aguilar-Guisado M. et al . Clinical progression of hepatitis C virus-related chronic liver disease in human immunodeficiency virus-infected patients undergoing highly active antiretroviral therapy.  Hepatology. 2007;  46 622-630
• 19 Qurishi N, Kreuzberg C, Luchters G. et al . Effect of antiretroviral therapy on liver-related mortality in patients with HIV and hepatitis C virus coinfection.  Lancet. 2003;  362 1708-1713
• 20 Ramos B, Nunez M, Rendon A. et al . Critical role of ribavirin for the achievement of early virological response to HCV therapy in HCV/HIV-coinfected patients.  J Viral Hepat. 2007;  14 387-391
• 21 Rockstroh J, Benhamou Y, Bhagani S. et al .European AIDS Clinical Society (EACS) Guidelines for the clinical management and treatment of chronic hepatitis B and C co-infection in HIV-infected adults – 2009.  http://www.europeanaidsclinicalsociety.org/guidelines.asp 2009
• 22 Rockstroh J K, Mocroft A, Soriano V. et al . Influence of hepatitis C virus infection on HIV-1 disease progression and response to highly active antiretroviral therapy.  J Infect Dis. 2005;  192 992-1002
• 23 Schmidt A, Vogel M, Krznaric I. et al .The trouble with bleeding: why do HIV-positive gay men get hepatitis C? 12th European AIDS Conference. Cologne, Germany; 2009 Abstract BPD1/7
• 24 Sherman K, Andersen J. et al .Sustained long-term antiviral maintenance with pegylated interferon in HCV/HIV-co-infected patients. 15th Conference on Retroviruses and Opportunistic Infections, Boston 2008. Abstract 59
• 25 Thomson E C, Nastouli E, Main J. et al . Delayed anti-HCV antibody response in HIV-positive men acutely infected with HCV.  Aids. 2009;  23 89-93
• 26 Trevino A, Rivas P, Herrero-Mendoza M. et al .Newly Diagnosed HIV-1 Individuals in Spain since year 2000. Non-B subtypes, and hepatitis C and B virus co-infections. 16th Conference on Retroviruses and Opportunistic Infections, Montreal. 2009 Abstract 300
• 27 Vispo E, Barreiro P, Pineda J A. et al . Low response to pegylated interferon plus ribavirin in HIV-infected patients with chronic hepatitis C treated with abacavir.  Antivir Ther. 2008;  13 429-437
• 28 Vogel M, Deterding K, Wiegand J. et al . Initial presentation of acute hepatitis C virus (HCV) infection among HIV-negative and HIV-positive individuals-experience from 2 large German networks on the study of acute HCV infection.  Clin Infect Dis. 2009;  49 317-319; author reply 319
• 29 Vogel M, Page E, Matthews G. et al .The use of week 4 HCV-RNA after acute HCV infection (AHC) to predict chronic HCV infection. 17th Conference on Retroviruses and Opportunistic Infections, San Francisco 2010, Abstract 640. 
• 30 Woitas R P, Stoschus B, Terjung B. et al . Hepatitis C-associated autoimmunity in patients coinfected with HIV.  Liver Int. 2005;  25 1114-1121