Westin J, Lindh M, Nenonen N, Lagging L M, Norkrans G, Wejstål R
Department of Infectious Diseases, Sahlgrenska University Hospital, Götehorg, Sweden.
Scand J Infect Dis. 2001;33(2):110-5. doi: 10.1080/003655401750065481.
Adding the nucleoside analog ribavirin (RBV) to interferon (IFN) for treatment of HCV has improved the sustained response rates, but the mechanism by which RBV mediates viral clearance is not fully understood. In this study, a highly sensitive method (Codes Amplicor HCV Monitor) was used to monitor the early (first 12 weeks of therapy) and long-term virological response in 20 patients who were treated first with IFN and later, due to non-sustained response, with IFN-RBV. All 10 IFN relapsers displayed a prompt virological response at week 4 to both IFN and IFN-RBV therapy; nine of them showed a sustained response to IFN-RBV. Out of 10 IFN non-responders, five showed a sustained response to IFN-RBV. Four of these were HCV RNA-negative at week 4 of IFN-RBV therapy and two of them had a transient early virological response (RNA-negative at weeks 4-8) to IFN alone. Overall, of the 14 patients (nine IFN relapsers, five IFN non-responders) with a sustained response to IFN-RBV, 11 and 13 had HCV RNA below 2000 copies/ml at week 4 of IFN and IFN-RBV, respectively, as compared with one and one of six patients without a sustained response to IFN-RBV (p < 0.02). Thus, addition of RBV to IFN increased both viral clearance during the first 12 weeks of therapy and the rate of sustained response. Loss of viremia at week 4 of IFN was associated with a sustained response to IFN-RBV and was seen in 11 of 13 patients (85%) with genotypes 2 or 3, as compared with one of seven patients (14%) with genotype 1 (p = 0.0044).
在干扰素（IFN）治疗丙型肝炎（HCV）时添加核苷类似物利巴韦林（RBV）可提高持续应答率，但RBV介导病毒清除的机制尚未完全明确。本研究采用一种高灵敏度方法（COBAS Amplicor HCV Monitor），对20例患者进行治疗早期（治疗的前12周）及长期病毒学应答监测。这些患者最初接受IFN治疗，因未获得持续应答，随后加用IFN-RBV治疗。所有10例IFN治疗复发者在第4周时对IFN和IFN-RBV治疗均迅速出现病毒学应答；其中9例对IFN-RBV显示持续应答。在10例IFN无应答者中，5例对IFN-RBV显示持续应答。其中4例在IFN-RBV治疗第4周时HCV RNA呈阴性，2例对单独IFN有短暂的早期病毒学应答（第4 - 8周时RNA呈阴性）。总体而言，在14例对IFN-RBV有持续应答的患者（9例IFN治疗复发者，5例IFN无应答者）中，分别有11例和13例在IFN及IFN-RBV治疗第4周时HCV RNA低于2000拷贝/ml，而在6例对IFN-RBV无持续应答的患者中，该数值分别为1例和1例（p < 0.02）。因此，在IFN基础上加用RBV可提高治疗前12周的病毒清除率及持续应答率。IFN治疗第4周时病毒血症消失与对IFN-RBV的持续应答相关，在13例基因2或3型患者中有11例（85%）出现这种情况，而在7例基因1型患者中仅有1例（14%）出现（p = 0.0044）。
