Viral hepatitis in persons living with HIV in the post-COVID era.

IF 1.9 4区 医学 Q4 IMMUNOLOGY
Vicente Soriano, Víctor Moreno-Torres, Carmen de Mendoza, Octavio Corral, Pablo Barreiro
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引用次数: 3

Abstract

Coinfection with hepatitis viruses A to E is frequent in persons living with HIV (PLWH) and causes significant morbidity and mortality. Oro-fecal transmissible hepatitis A and E mostly produce acute self-limited episodes in poor income regions and in non-vaccinated travelers. In high-income countries, outbreaks of hepatitis A occur in men having sex with men (MSM) and chronic hepatitis E is occasionally reported among PLWH with severe immunodeficiency. Chronic hepatitis B, C, and D are frequent in PLWH in highly endemic regions and globally in persons who inject drugs (PWID) and MSM. Progression to liver cirrhosis and development of hepatocellular carcinoma (HCC) is major clinical complications in coinfected patients. Current estimates for PLWH are of 38 million worldwide. Roughly 12% have chronic viral hepatitis (5 million). Coinfection figures are of 5-10% for HBV (2-4 million), 4% for HCV (1.5 million), and 15% of HBsAg+ for HDV (0.5 million). Oral direct-acting antivirals (DAA) cure almost all treated patients with hepatitis C. However, given that there is no protective HCV immunity, PLWH with high-risk behaviors may experience HCV reinfection episodes. Tenofovir is the drug of choice in PLWH with chronic hepatitis B, given its dual effect on HIV and HBV. Lifelong oral tenofovir suppresses HBV replication and ameliorate liver damage. However, the risk of HCC persists even in the absence of cirrhosis. Finally, HDV causes the worst of viral hepatitis with faster progression to cirrhosis and HCC. An entry inhibitor, bulevirtide, has recently been approved and another drug, lonafarnib, is completing Phase 3 trials. Combination antiviral therapy for hepatitis D could improve dramatically the poor prognosis of HIV-HDV coinfected patients. The resumption of good medical practices in PLWH after the big disruption caused by COVID-19 will reduce the burden of viral hepatitis coinfections. Renewed efforts on HAV and HBV vaccination of susceptible individuals and earlier and wider prescription of antiviral therapy for HBV, HCV, and/or HDV coinfection should be prioritized in PLWH. The benefits of innovative strategies for viral hepatitis, including pre-exposure prophylaxis or use of long-acting antivirals, warrant further consideration in PLWH.

后covid时代艾滋病毒感染者的病毒性肝炎。
同时感染甲型至戊型肝炎病毒在艾滋病毒感染者(PLWH)中很常见,并导致显著的发病率和死亡率。在贫穷收入地区和未接种疫苗的旅行者中,经口粪便传播的甲型和戊型肝炎大多产生急性自限性发作。在高收入国家,甲型肝炎暴发发生在男男性行为者(MSM)中,慢性戊型肝炎偶有报道发生在患有严重免疫缺陷的艾滋病毒感染者中。慢性乙型、丙型和丁型肝炎在高流行地区和全球注射吸毒者(PWID)和男男性行为者中很常见。进展为肝硬化和发展为肝细胞癌是合并感染患者的主要临床并发症。目前估计全世界有3800万艾滋病患者。大约12%的人患有慢性病毒性肝炎(500万)。乙肝病毒共感染5-10%(2- 400万),丙肝病毒共感染4%(150万),乙肝表面抗原+ HDV共感染15%(50万)。口服直接作用抗病毒药物(DAA)几乎治愈了所有丙型肝炎患者。然而,由于没有保护性的HCV免疫,有高危行为的PLWH可能会出现HCV再感染事件。考虑到替诺福韦对HIV和HBV的双重作用,替诺福韦是慢性乙型肝炎PLWH患者的首选药物。终生口服替诺福韦可抑制HBV复制并改善肝损伤。然而,即使没有肝硬化,HCC的风险仍然存在。最后,HDV引起最严重的病毒性肝炎,迅速发展为肝硬化和HCC。一种进入抑制剂bulevirtide最近获得批准,另一种药物lonafarnib正在完成3期试验。联合抗病毒治疗丁型肝炎可显著改善HIV-HDV合并感染患者的不良预后。在2019冠状病毒病造成严重破坏后,在公共卫生机构恢复良好医疗做法将减轻病毒性肝炎合并感染的负担。在艾滋病毒感染者中,应优先重新努力对易感个体进行甲肝和乙肝疫苗接种,并对HBV、HCV和/或HDV合并感染进行更早和更广泛的抗病毒治疗处方。病毒性肝炎创新策略的益处,包括暴露前预防或使用长效抗病毒药物,值得PLWH进一步考虑。
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来源期刊
AIDS reviews
AIDS reviews 医学-传染病学
CiteScore
3.40
自引率
4.50%
发文量
41
审稿时长
>12 weeks
期刊介绍: AIDS Reviews publishes papers reporting original scientific, clinical, epidemiologic and social research which contribute to the overall knowledge of the field of the acquired immunodeficiency syndrome and human retrovirology. Currently, the Journal publishes review articles (usually by invitation, but spontaneous submitted articles will also be considered). Manuscripts submitted to AIDS Reviews will be accepted on the understanding that the authors have not submitted the paper to another journal or published the material elsewhere.
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