HIV合并肝病的处理-20130111试题.ppt

HIVHBV合并感染的探索-李太生教授专题访谈 柰韦拉平引起的肝损广为人知，其他ART？ ARV药物的肝毒性 Intergrase inhibitors RAL 依非韦伦引起肝细胞损伤的机制 治疗浓度的依非韦伦可导致细胞自噬，特别是肝细胞线粒体自噬。这是细胞生存的更新过程，但超出一定限度则导致线粒体功能障碍，这可能是导致肝损的机制之一 HIV / HCV patients with liver function recovery after treatment with anti-HCV HAART+Anti-HCV Anti-HCV HIV/HCV-LPV/r From：Unpublished Resherch report of Eleven?Fifth Key Research, China (NO: 2008Z STAR研究 克力芝单药及联合治疗均改善认知功能障碍 The three free HAART regimens on the HIV / HCV immunological response 3 regimens have no significant difference in anti-HIV efficacy, all of them can reduce HIV-RNA effectively The three regimens all increase CD4 during the treatment period, LPV/r increases CD4 more significantly HIV/HCV Immune Reconstitution is worse than HIV（p＜0.05） From：Unpublished Resherch report of Eleven?Fifth Key Research, China (NO: 2008Z 不同药物对免疫重建的影响 EuroSIDA cohort (1999-2005) Mocroft A, et al. AIDS 2006;20:1141–50 * Nelson的研究报告的是IDU人群中HCV和HBV的感染率，而非HIV/HBV，HIV/HCV合并感染率 * * HBV单纯感染的肝病相关死亡率0.8/1000人年；HIV/HBV合并感染的肝病相关死亡率14.2/1000人年。 * * 艾滋病相关疾病的发病率在HBV阴性和阳性的HIV感染者中相近，3.3 vs 3.4。HBVsAg阳性也不是艾滋病相关疾病的危险因素。 * * 无论从病毒载量的控制还是CD4的增加，HBV对ART的治疗效果均没有显著影响。 * * 慢性HBV感染出现4级肝酶升高的风险是HBV阴性者的9.2倍，出现3或4级肝酶升高的风险是4.6倍。 * * 慢性HCV感染出现4级肝酶升高的风险是HBV阴性者的5倍，出现3或4级肝酶升高的风险是3.2倍。（此张幻灯在之前说明HBV增加ART药物肝毒性时也用过） * * * 十一五国家重大专项课题结果（未发表）显示：无论是否同时HAART，抗HCV后都能够使肝功能恢复。但以Kaletra为基础的方案ALT的降低与没有用HAART的一样，明显优于Nevirapine或Efavirenz为基础的方案。 * 十一五国家重大专项课题结果（未发表）显示： HAART后HIV/HCV组CD4上升较HIV组差。但3种治疗方案中，相对而言Kaletra方案优于其余2组以NNRTIs的方案。 The CD4+ cell count increased in 55.8% of VL pairs, with an overall mean annual increase of 45.5 μL. This figure demonstrates the predicted adjusted mean annual change in CD4+ based on the cART regimen. The estimates are based on analyses of raw data adjusted for other antiretroviral regimens, age, whether or not the patient was antiretroviral na?ve prior to starting cART, CD4+ count, time since initiation of cART, and change in CD4+ count since starting cART. These adjustments were especially importa