HBVHCV艾滋病的防治-培训课件.ppt

* * * * * * * * * * Screening individuals at risk: Anyone with elevated ALT, anyone with blood products prior to 1992, anyone with any exposure to injection drug use. Confirm HCV infection with PCR. Choice of PCR should be driven by AST/ALT level. True normal ALT/AST should be under 30. If ALT/AST normal, HCV may have resolved so first test should be Qual PCR. If ALT/AST over 30, HCV infection is extremely likely, so should go straight to Genotyping/Viral load. This will give the patients an idea of potential treatment response – do they want to be assessed/referred for treatment. It will also help specialists at the initial visit. * * * * * * * * * * Slide #45: Fitted Probability of 24-Week Decompensation Multivariate modelling resulted in two best-fitting models containing four variables: higher total bilirubin, lower hemoglobin, didanosine treatment, and lower platelets. The association between didanosine and hepatic decompensation suggests that an interaction between antiretroviral drugs and HCV treatment must be considered. Although the sample size of this study is rather small and may not allow definitive conclusions, for the time being didanosine should be avoided or replaced in patients with frank or incomplete cirrhosis. Reference Mauss S, Valenti W, DePamphilis J, et al. Risk factors for hepatic decompensation in patients with HIV/HCV coinfection and liver cirrhosis during interferon-based therapy. AIDS. 2004;18:21-25. * Choice of treatment治疗的选择 Treat HBV and HIV 3TC/FTC-TDF + HIV agent Treat HBV but NOT HIV Interferons? Telbivudine? Worry about HIV at 3TC Adefovir? Worry about HIV at TDF Entecavir – NO Treat HIV but NOT HBV? Avoid 3TC-FTC-TDF? Monitoring（监测） Not on treatment（未治疗） Changes in status that require treatment（状况发生变化需要治疗） Hepatoma screening if risk is high（危险度很高时作肝癌筛查） On treatment（治疗） Continued virological suppression 200 IU/mL（持续的病毒载量被控制在200 IU/ml） Changes in renal function to eGFR 50（肾功能改变，肾小球滤过率50） Hepatoma screening if risk is high