HBV/HCV重叠感染的抗病毒治疗

Antiviral treatment of hepatitis B virus and hepatitis C virus co-infection

从全球范围看,乙型肝炎病毒(hepatitis B virus,HBV)和丙型肝炎病毒(hepatitis C virus,HCV)重叠感染估计约有700-2000万人口感染.重叠感染和单一HBV或HCV感染比较,更易发展为肝硬化、肝细胞癌甚至肝衰竭的比例也高,HBV和HCV重叠感染可有四种不同的临床模式,即HCV活动伴HBV非活动,HBV活动伴HCV非活动,HBV与HCV混合感染,HBV与HCV病毒均不可测,对重叠感染的治疗,需根据不同的临床模式进行评估,采用不同的治疗方案,治疗前后均需监测HBV和HCV病毒学指标和生化学指标的变化.防止"优势"模式的转换而出现肝炎的复发.

Hepatitis B virus（HBV）and hepatitis C virus（HCV）infections are among the most common causes of advanced chronic liver disease worldwide.HBV/HCV co-infection is not uncommon with an estimated 7-20 million individuals affected worldwide.Patients with HBV/HCV coinfection have an increased risk of cirrhosis,hepatocellular carcinoma（HCC）,and even death.The pathophysiology of HBV/HCV coinfection is complex,as different patterns o virological dominance may occur,which can even fluctuate over time.Recently,combination of pegylated interferon（PEG-IFN）plus ribavirin has been explored in HBV/HCV-coinfected patients who are positive for HCV-RNA.In this paper,we summarize the epidemiology,viral interaction and clinical features of HBV/HCV co-infection and the available treatment options.Detailed serological and virological evaluations are required for HBV/HCV-co-infected patients before initiation of antiviral therapy.At present,PEG-IFN-a plus ribavirin should be the treatment of choice in patients with dominant HCV replication.However,HBV rebound may occur after elimination of HCV,and thus close monitoring for both viruses is recommended even for patients with initially suppressed HBV DNA.