篇名 | 愛滋感染者C型肝炎治療之新進展 |
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卷期 | 31:5 |
並列篇名 | Advance in the Treatment of HCV Infection in HIV-infected Patients |
作者 | 黃于珊 、 盛望徽 |
頁次 | 313-317 |
關鍵字 | C型肝炎 、 人類免疫缺乏病毒 、 愛滋病 、 直接作用抗病毒藥物 、 藥物交互作用 、 Hepatitis C 、 Human immunodeficiency virus 、 Acquired Immunodeficiency Syndrome 、 Direct-acting antiviral agent 、 Drug-drug interaction 、 Scopus 、 TSCI |
出刊日期 | 202010 |
DOI | 10.6314/JIMT.202010_31(5).04 |
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tenofovir disoproxil 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。
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.