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.

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

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

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