HIV/HCV双重感染者抗HCV治疗时机的探讨

目的探讨HIV/HCV双重感染者抗HCV治疗的时机。方法根据基线CD4+T淋巴细胞计数将HIV/HCV双重感染者分为A、B、C 3组,A组19例(CD4+T淋巴细胞计数>350个/μl)采用聚乙二醇干扰素α-2a(PEG-IFNα-2a)135或180μg皮下注射,1次/周,利巴韦林900～1 200 mg口服,1次/d,48周为1个疗程;B组14例(CD4+T淋巴细胞计数200～350个/μl)先给予高效抗反转录病毒治疗(HAART)治疗8周,再采用A组相同的方案治疗;C组30例(CD4+T淋巴细胞计数<200个/μl)先给予HAART,复查CD4+T淋巴细胞计数>200个/μl并持续8周以上再采用A组相同方案治疗。分别在基线及治疗后12周、24周、48周、72周复查患者丙型肝炎病毒RNA(HCV-RNA)和CD4+T淋巴细胞计数。结果 3组患者中早期病毒学应答(EVR)29例(46.03%),持续病毒学应答(SVR)28例(44.44%)。A+B组的EVR(69.70%)和SVR(66.67%)均高于C组(EVR为20.00%、SVR为20.00%)。结论 CD4+T淋巴细胞计数>200个/μl是HIV/HCV双重感染者抗HCV治疗的最佳时机,其疗效和单纯丙肝患者相近,但CD4+T淋巴细胞计数<200个/μl者疗效较差。

Best Time of Carrying on Anti-HCV Treatment in Patients Coinfected with HIV/HCV

Objective To discuss the best time of carrying on antiviral therapy against hepatitis C virus(HCV)in patients coinfected with HIV and HCV.Methods According to the CD+4 T lymphocytes count,we divided the patients enrolled into three groups:Group A(n=19)whose CD+4 T lymphocytes count was above 350/μl,Group B(n=14)whose CD+4 T lymphocytes count was between 200/μl and 350/μl and Group C(n=30)whose CD+4 T lymphocytes was under 200/μl.Group A was administered pegylated interferon α-2a 135 or 180 μg/week,subcutaneous injection,plus ribavirin 900~1 200 mg/d,oral,course of treatment with 48 weeks.Group B received the same therapy program as group A after 8 weeks of HAART.For group C,HAART was given firstly and then the same therapy program as group A was performed after CD+4 T lymphocytes reached 200/μl and lasted for 2 or more months.All cases were tested baseline HCV-RNA and CD+4 T lymphocytes,which were re-examined 12 weeks,24 weeks,48 weeks and 72 weeks after corresponding treatments,respectively.Results The early virological response(EVR)and sustained virological response(SVR)of all cases were 29 cases(46.03%)and 28 cases(44.44%)on the average.The EVR and SVR of A+B group(EVR 69.70%,SVR 66.67%)were higher than those of the group C(EVR 20.00%,SVR 20.00%).Conclusion CD+4 T lymphocytes count above 200/μl is the most suitable time for patients coinfected with HIV/HCV to receive anti-HCV treatment,which can have a similar curative effect as the pure HCV patients.Otherwise,the curative effect is very poor.