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Chinese expert consensus on the diagnosis and treatment of HIV co-infection with HBV and HCV
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Key words:
- HIV /
- Hepatitis B virus /
- Hepacivirus /
- Coinfection /
- Consensus
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表 1 目前我国主要的DAA方案
Table 1. Current major direct antiviral drug therapeutic regimens in China
类别 药品 规格 使用剂量 泛基因型方案 NS5B聚合酶核苷类似物抑制剂/NS5A抑制剂 SOF/VEL 400 mg SOF和100 mg VEL，复合片剂 1片，1次/d NS5A抑制剂+NS5B聚合酶核苷类似物抑制剂 CLP+SOF 60 mg CLP，胶囊 400 mg SOF，片剂 CLP 1粒，1次/d SOF 1片，1次/d NS5B聚合酶核苷类似物抑制剂/NS5A抑制剂/NS3/4A蛋白酶抑制剂 SOF/VEL/VOX 400 mg SOF、100 mg VEL、100 mg VOX，复合片剂 1片，1次/d 基因型特异性方案 NS3/4A蛋白酶抑制剂/NS5A抑制剂 EBR/GZR：适用于基因1b、4型 50 mg EBR和100 mg GZR，复合片剂 1片，1次/d NS5A抑制剂/NS5B聚合酶核苷类似物抑制剂 LDV/SOF：适用于基因1、2、4、5、6型 90 mg LDV和400 mg SOF，复合片剂 1片，1次/d NS5A抑制剂+NS3/4A蛋白酶抑制剂 RDV+DNV：适用于基因1b型 200 mg RDV，片剂 100 mg DNV，片剂 RDV 1片，1次/d DNV 1片，2次/d NS5A抑制剂+NS5B聚合酶核苷类似物抑制剂 EMV+SOF：适用于基因1b型 100 mg EMV，胶囊 400 mg SOF，片剂 EMV 1粒，1次/d SOF 1片，1次/d 
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表 2 部分DAA与cART药物的相互作用
Table 2. Interactions between some of the direct antiviral drugs and combined antiretroviral drugs
药物名称 ATV/c ATV/r DRV/c DRV/r LPV/r DOR EFV ETV NVP RPV FTR LEN MVC BIC CAB/RPV DTG EVG/c RAL TAF TDF SOF SOF/VEL SOF/VEL/VOX EBR/GZR LDV/SOF 注：绿色代表预计无临床意义的相互作用；红色代表不应当联合用药；橙色代表潜在临床意义上的相互作用，可能需要额外监测、改变药物剂量或安排管理时间；黄色代表潜在的相互作用，可能会弱化强度，不需要额外的监测或剂量调整。ATV/c，阿扎那韦/考比司他；ATV/r，阿扎那韦/利托那韦；DRV/c，达芦那韦/考比司他；DRV/r，达芦那韦/利托那韦；DOR，多拉韦林；FTR，fostemsavir；LEN，lenacapavir；MCV，马拉韦罗；BIC，比克替拉韦；CAB，卡替拉韦；DTG，多替拉韦；EVG/c，艾维雷韦/考比司他；RAL，拉替拉韦。
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[1] World Health Organization. HIV/AIDS[EB/OL].( 2023‑07‑13)[ 2023-11-01]. https://www.who.int/zh/news-room/fact-sheets/detail/hiv-aids. https://www.who.int/zh/news-room/fact-sheets/detail/hiv-aids [2] World Health Organization. Hepatitis B[EB/OL].( 2023‑07‑18)[ 2023-11-01]. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b [3] World Health Organization. Hepatitis C[EB/OL].( 2023‑07‑18)[ 2023-11-01]. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c [4] PLATT L, EASTERBROOK P, GOWER E, et al. Prevalence and burden of HCV co-infection in people living with HIV: A global systematic review and meta-analysis[J]. Lancet Infect Dis, 2016, 16( 7): 797- 808. DOI: 10.1016/S1473-3099(15)00485-5. [5] LEUMI S, BIGNA JJ, AMOUGOU MA, et al. Global burden of hepatitis B infection in people living with human immunodeficiency virus: A systematic review and meta-analysis[J]. Clin Infect Dis, 2020, 71( 11): 2799- 2806. DOI: 10.1093/cid/ciz1170. [6] ZHANG FJ, ZHU H, WU YS, et al. HIV, hepatitis B virus, and hepatitis C virus co-infection in patients in the China National Free Antiretroviral Treatment Program, 2010-12: A retrospective observational cohort study[J]. Lancet Infect Dis, 2014, 14( 11): 1065- 1072. DOI: 10.1016/S1473-3099(14)70946-6. [7] CAO Y, ZHOU MH, ZHAI XJ. Prevalence of HBV co-infection in HIV-positive population in China: A systematic review and Meta-analysis[J]. Chin J Epidemiol, 2021, 42( 2): 327- 334. DOI: 10.3760/cma.j.cn112338-20200727-00987.曹阳, 周明浩, 翟祥军. 我国HIV感染者合并感染HBV现况[J]. 中华流行病学杂志, 2021, 42( 2): 327- 334. DOI: 10.3760/cma.j.cn112338-20200727-00987. [8] SMITH CJ, RYOM L, WEBER R, et al. Trends in underlying causes of death in people with HIV from 1999 to 2011(D: A: D): A multicohort collaboration[J]. Lancet, 2014, 384( 9939): 241- 248. DOI: 10.1016/S0140-6736(14)60604-8. [9] GUO PL/Y), CAI WP, CHEN XJ, et al. Research on the causes of death associated with combined effects of HBV and HCV infection in patients with acquired immunodeficiency syndrome[J]. Chin J Hepatol, 2018, 26( 7): 495- 498. DOI: 10.3760/cma.j.issn.1007-3418.2018.07.003.郭朋乐, 蔡卫平, 陈谐捷, 等. 合并HBV、HCV感染对获得性免疫缺陷综合征患者死亡原因影响的研究[J]. 中华肝脏病杂志, 2018, 26( 7): 495- 498. DOI: 10.3760/cma.j.issn.1007-3418.2018.07.003. [10] 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[J]. Hepatology, 1999, 30( 4): 1054- 1058. DOI: 10.1002/hep.510300409. [11] GRAHAM CS, BADEN LR, YU E, et al. Influence of human immunodeficiency virus infection on the course of hepatitis C virus infection: A meta-analysis[J]. Clin Infect Dis, 2001, 33( 4): 562- 569. DOI: 10.1086/321909. [12] MACÍAS J, BERENGUER J, JAPÓN MA, et al. Fast fibrosis progression between repeated liver biopsies in patients coinfected with human immunodeficiency virus/hepatitis C virus[J]. Hepatology, 2009, 50( 4): 1056- 1063. DOI: 10.1002/hep.23136. [13] CHALOUNI M, POL S, SOGNI P, et al. Increased mortality in HIV/HCV-coinfected compared to HCV-monoinfected patients in the DAA era due to non-liver-related death[J]. J Hepatol, 2021, 74( 1): 37- 47. DOI: 10.1016/j.jhep.2020.08.008. [14] GREUB G, LEDERGERBER B, BATTEGAY M, et al. Clinical progression, survival, and immune recovery during antiretroviral therapy in patients with HIV-1 and hepatitis C virus coinfection: The Swiss HIV Cohort Study[J]. Lancet, 2000, 356( 9244): 1800- 1805. DOI: 10.1016/s0140-6736(00)03232-3. [15] SULKOWSKI MS, MOORE RD, MEHTA SH, et al. Hepatitis C and progression of HIV disease[J]. JAMA, 2002, 288( 2): 199- 206. DOI: 10.1001/jama.288.2.199. [16] ANDERSON KB, GUEST JL, RIMLAND D. Hepatitis C virus coinfection increases mortality in HIV-infected patients in the highly active antiretroviral therapy era: Data from the HIV Atlanta VA Cohort Study[J]. Clin Infect Dis, 2004, 39( 10): 1507- 1513. DOI: 10.1086/425360. [17] SHENG WH, CHEN MY, HSIEH SM, et al. Impact of chronic hepatitis B virus(HBV) infection on outcomes of patients infected with HIV in an area where HBV infection is hyperendemic[J]. Clin Infect Dis, 2004, 38( 10): 1471- 1477. DOI: 10.1086/420744. [18] KONOPNICKI D, MOCROFT A, WIT SD, et al. Hepatitis B and HIV: Prevalence, AIDS progression, response to highly active antiretroviral therapy and increased mortality in the EuroSIDA cohort[J]. AIDS, 2005, 19( 6): 593- 601. DOI: 10.1097/01.aids.0000163936.99401.fe. [19] ZHOU JL, DORE GJ, ZHANG FJ, et al. Hepatitis B and C virus coinfection in The TREAT Asia HIV Observational Database[J]. J Gastroenterol Hepatol, 2007, 22( 9): 1510- 1518. DOI: 10.1111/j.1440-1746.2007.05062.x. [20] WEIS N, LINDHARDT BO, KRONBORG G, et al. Impact of hepatitis C virus coinfection on response to highly active antiretroviral therapy and outcome in HIV-infected individuals: A nationwide cohort study[J]. Clin Infect Dis, 2006, 42( 10): 1481- 1487. DOI: 10.1086/503569. [21] WANG HL, LI YJ, ZHANG CD, et al. Immunological and virological responses to combined antiretroviral therapy in HIV/hepatitis B virus-coinfected patients from a multicenter cohort[J]. AIDS, 2012, 26( 14): 1755- 1763. DOI: 10.1097/qad.0b013e328355ced2. [22] YOSHIKAWA S, YOSHIO S, YOSHIDA Y, et al. Impact of immune reconstitution-induced hepatic flare on hepatitis B surface antigen loss in hepatitis B virus/human immunodeficiency virus-1 coinfected patients[J]. J Infect Dis, 2021, 223( 12): 2080- 2089. DOI: 10.1093/infdis/jiaa662. [23] AVIHINGSANON A, LU HZ, LEONG CL, et al. Bictegravir, emtricitabine, and tenofovir alafenamide versus dolutegravir, emtricitabine, and tenofovir disoproxil fumarate for initial treatment of HIV-1 and hepatitis B coinfection(ALLIANCE): A double-blind, multicentre, randomised controlled, phase 3 non-inferiority trial[J]. Lancet HIV, 2023, 10( 10): e640- e652. DOI: 10.1016/S2352-3018(23)00151-0. [24] HE YZ, LIN WY, LI H, et al. Incidence and factors associated with hepatitis B surface antigen seroclearance in patients co-infected with HBV/HIV during antiretroviral therapy in Guangdong, China[J]. Chin Med J, 2023, 136( 22): 2686- 2693. DOI: 10.1097/CM9.0000000000002886. [25] LIN WY, WANG XC, ZHANG JB, et al. A simple, feasible, efficient and safe treatment strategy of sofosbuvir/velpatasvir for chronic HCV/HIV-1 coinfected patients regardless of HCV genotypes: A multicenter, open-label study in China[J]. Lancet Reg Health West Pac, 2023, 36: 100749. DOI: 10.1016/j.lanwpc.2023.100749. [26] NAGGIE S, COOPER C, SAAG M, et al. Ledipasvir and sofosbuvir for HCV in patients coinfected with HIV-1[J]. N Engl J Med, 2015, 373( 8): 705- 713. DOI: 10.1056/NEJMoa1501315. [27] OSINUSI A, TOWNSEND K, KOHLI A, et al. Virologic response following combined ledipasvir and sofosbuvir administration in patients with HCV genotype 1 and HIV co-infection[J]. JAMA, 2015, 313( 12): 1232- 1239. DOI: 10.1001/jama.2015.1373. [28] WYLES D, BRÄU N, KOTTILIL S, et al. Sofosbuvir and velpatasvir for the treatment of hepatitis C virus in patients coinfected with human immunodeficiency virus type 1: An open-label, phase 3 study[J]. Clin Infect Dis, 2017, 65( 1): 6- 12. DOI: 10.1093/cid/cix260. [29] LIU CH, SUN HY, LIU CJ, et al. Generic velpatasvir plus sofosbuvir for hepatitis C virus infection in patients with or without human immunodeficiency virus coinfection[J]. Aliment Pharmacol Ther, 2018, 47( 12): 1690- 1698. DOI: 10.1111/apt.14647. [30] PES F, ONALI S, BALESTRIERI C, et al. HCV treatment in Sardinian HIV-HCV coinfected patients: A real-life perspective study on safety, efficacy, and immune reconstitution[J]. Expert Rev Anti Infect Ther, 2022, 20( 11): 1509- 1516. DOI: 10.1080/14787210.2022.2130893. [31] AKHTAR A, FATIMA S, SAEED H, et al. HIV-HCV coinfection: Prevalence and treatment outcomes in Malaysia[J]. Intervirology, 2022, 65( 2): 87- 93. DOI: 10.1159/000518836. [32] KRONFLI N, YOUNG J, WANG SA, et al. Liver fibrosis in human immunodeficiency virus(HIV)-hepatitis C virus(HCV) coinfection before and after sustained virologic response: What is the best noninvasive marker for monitoring regression?[J]. Clin Infect Dis, 2021, 73( 3): 468- 477. DOI: 10.1093/cid/ciaa702. [33] MOCROFT A, LUNDGREN J, GERSTOFT J, et al. Clinical outcomes in persons coinfected with HIV and HCV: Impact of HCV treatment[J]. Clin Infect Dis, 2020, 70( 10): 2131- 2140. DOI: 10.1093/cid/ciz601. [34] SALMON-CERON D, NAHON P, LAYESE R, et al. Human immunodeficiency virus/hepatitis C virus(HCV) co-infected patients with cirrhosis are No longer at higher risk for hepatocellular carcinoma or end-stage liver disease as compared to HCV mono-infected patients[J]. Hepatology, 2019, 70( 3): 939- 954. DOI: 10.1002/hep.30400. [35] CORMA-GÓMEZ A, MACÍAS J, LACALLE-REMIGIO JR, et al. Human immunodeficiency virus(HIV) infection is associated with lower risk of hepatocellular carcinoma after sustained virological response to direct-acting antivirals in hepatitis C infected patients with advanced fibrosis[J]. Clin Infect Dis, 2021, 73( 7): e2109- e2116. DOI: 10.1093/cid/ciaa1111. [36] BRESKIN A, WESTREICH D, HURT CB, et al. The effects of hepatitis C treatment eligibility criteria on all-cause mortality among people with human immunodeficiency virus[J]. Clin Infect Dis, 2019, 69( 9): 1613- 1620. DOI: 10.1093/cid/ciz008. [37] Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B(2022 version)[J]. Chin J Infect Dis, 2023, 41( 1): 3- 28. DOI: 10.3760/cma.j.cn311365-20230220-00050.中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. Chin J Infect Dis, 2023, 41( 1): 3- 28. DOI: 10.3760/cma.j.cn311365-20230220-00050. [38] FASANO M, POLISENO MC, FIORE JR, et al. Management of chronic hepatitis B in HIV-coinfected patients[J]. Viruses, 2022, 14( 9): 2022. DOI: 10.3390/v14092022. [39] SHARMA SA, KOWGIER M, HANSEN BE, et al. Toronto HCC risk index: A validated scoring system to predict 10-year risk of HCC in patients with cirrhosis[J]. J Hepatol, 2017: S0168-S8278(17)32248- 1. DOI: 10.1016/j.jhep.2017.07.033. [40] FAN R, PAPATHEODORIDIS G, SUN J, et al. aMAP risk score predicts hepatocellular carcinoma development in patients with chronic hepatitis[J]. J Hepatol, 2020, 73( 6): 1368- 1378. DOI: 10.1016/j.jhep.2020.07.025. [41] FAN R, CHEN L, ZHAO SR, et al. Novel, high accuracy models for hepatocellular carcinoma prediction based on longitudinal data and cell-free DNA signatures[J]. J Hepatol, 2023, 79( 4): 933- 944. DOI: 10.1016/j.jhep.2023.05.039. [42] Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese MedicaI Assocbtion. The guide ̈ne Of prevention and treatment for hepatitis C: a 2022 update[J]. CIin J Infect Dis, 2023, 41( 1): 29- 46. DOI: 10.3760/cma.j.cn311365-20230217-00045.中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2022年版)[J]. 中华传染病杂志, 2023, 41( 1): 29- 46. DOI: 10.3760/cma.j.cn311365-20230217-00045. [43] LIN WY, ZHONG HL, WEN CY, et al. Persistently low CD4 cell counts are associated with hepatic events in HCV/HIV coinfected patients: Data from the national free antiretroviral treatment program of China[J]. Chin Med J, 2022, 135( 22): 2699- 2705. DOI: 10.1097/CM9.0000000000002502. [44] Chinese Foundation for Hepatitis Prevention and Control, Chinese Society of Infectious Disease and Chinese Society of Hepatology, Chinese Medical Association Liver Disease Committee of Chinese Research Hospital Association. Consensus on clinical application of transient elastography detecting liver fibrosis: A 2018 update[J]. Chin J Hepatol, 2019, 27( 3): 182- 191. DOI: 10.3760/cma.j.issn.1007-3418.2019.03.004.中国肝炎防治基金会, 中华医学会感染病学分会, 中华医学会肝病学分会和中国研究型医院学会肝病专业委员会. 瞬时弹性成像技术诊断肝纤维化专家共识(2018年更新版)[J]. 中华肝脏病杂志, 2019, 27( 3): 182- 191. DOI: 10.3760/cma.j.issn.1007-3418.2019.03.004. [45] WAI CT, GREENSON JK, FONTANA RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C[J]. Hepatology, 2003, 38( 2): 518- 526. DOI: 10.1053/jhep.2003.50346. [46] STERLING RK, LISSEN E, CLUMECK N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection[J]. Hepatology, 2006, 43( 6): 1317- 1325. DOI: 10.1002/hep.21178. [47] AIDS and Hepatitis C Professional Group, Society of Infectious Diseases, Chinese Medical Association; Chinese Center for Disease Control and Prevention. Guidelines for AIDS diagnosis and treatment in China(2021 edition)[J]. Chin J AIDS STD, 2021, 27( 11): 1182- 1201. DOI: 10.13419/j.cnki.aids.2021.11.02.中华医学会感染病学分会艾滋病丙型肝炎学组, 中国疾病预防控制中心. 中国艾滋病诊疗指南(2021年版)[J]. 中国艾滋病性病, 2021, 27( 11): 1182- 1201. DOI: 10.13419/j.cnki.aids.2021.11.02. [48] SURIAL B, BÉGUELIN C, CHAVE JP, et al. Brief report: Switching from TDF to TAF in HIV/HBV-coinfected individuals with renal dysfunction-a prospective cohort study[J]. J Acquir Immune Defic Syndr, 2020, 85( 2): 227- 232. DOI: 10.1097/QAI.0000000000002429. [49] EACS. EACS Guidelines version 11.1, October 2022[EB/OL].( 2022-10-01)[ 2023-11-01]. https://www.eacsociety.org/media/guidelines-11.1_final_09-10.pdf. https://www.eacsociety.org/media/guidelines-11.1_final_09-10.pdf [50] Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services[EB/OL].( 2022-09-01)[ 2023-11-01]. https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv. https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv [51] Panel on Opportunistic Infections in HIV-Infected Adults andAdolescents. Guidelines for the prevention and treatment of opportunistic Infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America[EB/OL].( 2022-04-12)[ 2023-11-01]. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-oi/guidelines-adult-adolescent-oi.pdf. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-oi/guidelines-adult-adolescent-oi.pdf [52] EKE AC, BROOKS KM, GEBREYOHANNES RD, et al. Tenofovir alafenamide use in pregnant and lactating women living with HIV[J]. Expert Opin Drug Metab Toxicol, 2020, 16( 4): 333- 342. DOI: 10.1080/17425255.2020.1738384. [53] WHO. Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection[EB/OL].( 2018-07-01)[ 2023-11-01]. https://www.who.int/publications/i/item/9789241550345. https://www.who.int/publications/i/item/9789241550345 [54] SIKAVI C, CHEN PH, LEE AD, et al. Hepatitis C and human immunodeficiency virus coinfection in the era of direct-acting antiviral agents: No longer a difficult-to-treat population[J]. Hepatology, 2018, 67( 3): 847- 857. DOI: 10.1002/hep.29642. [55] SCHERZER R, SHLIPAK MG. Individual assessment of CKD risk in HIV-positive patients[J]. Nat Rev Nephrol, 2015, 11: 392- 393. DOI: 10.1038/nrneph.2015.75. [56] GORDON CE, BERENGUER MC, DOSS W, et al. Prevention, diagnosis, evaluation, and treatment of hepatitis C virus infection in chronic kidney disease: Synopsis of the kidney disease: Improving global outcomes 2018 clinical practice guideline[J]. Ann Intern Med, 2019, 171( 7): 496- 504. DOI: 10.7326/M19-1539. [57] EACS. EACS Guidelines version 12.0, October 2023[EB/OL].( 2023-10-01)[ 2023-11-01]. https://www.eacsociety.org/media/guidelines-12.0.pdf. https://www.eacsociety.org/media/guidelines-12.0.pdf -
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