Shiffman Mitchell L
Hepatology Section, Virginia Commonwealth University Health System, Medical College of Virginia, Richmond, VA 23298, USA.
Hepatology. 2002 Nov;36(5 Suppl 1):S128-34. doi: 10.1053/jhep.2002.36816.
Significant advances have been made in the treatment of chronic hepatitis C virus (HCV) infection during the past 5 years. As a consequence, there is continuing enthusiasm for retreating patients who did not achieve sustained virological response (SVR) with previous therapy. Retreatment of non-responders to standard interferon monotherapy using interferon and ribavirin has yielded SVR rates of 12% to 15%. Retreatment with peginterferon and ribavirin has been more effective; achieving SVR rates of 34% to 40%. Retreatment of patients who relapsed after interferon monotherapy using standard interferon and ribavirin yielded SVR rates of 47%, whereas retreatment with peginterferon and ribavirin resulted in an SVR rate of about 60%. The major factors associated with a higher likelihood of an SVR after retreatment include previous relapse, previous treatment with interferon monotherapy, HCV genotypes 2 or 3, lower serum levels of HCV RNA, and having a significant decrease in HCV RNA levels during the initial course of therapy. These results help to focus retreatment with peginterferon and ribavirin on subsets of patients who are most likely to benefit.
在过去5年中，慢性丙型肝炎病毒（HCV）感染的治疗取得了重大进展。因此，对于那些先前治疗未实现持续病毒学应答（SVR）的患者进行再次治疗，仍不断受到关注。使用干扰素和利巴韦林对标准干扰素单药治疗无应答者进行再次治疗，SVR率为12%至15%。聚乙二醇干扰素和利巴韦林再次治疗更有效，SVR率达到34%至40%。使用标准干扰素和利巴韦林对干扰素单药治疗后复发的患者进行再次治疗，SVR率为47%，而聚乙二醇干扰素和利巴韦林再次治疗的SVR率约为60%。再次治疗后SVR可能性较高的主要因素包括先前复发、先前接受干扰素单药治疗、HCV基因2型或3型、较低的血清HCV RNA水平，以及在初始治疗过程中HCV RNA水平显著下降。这些结果有助于将聚乙二醇干扰素和利巴韦林的再次治疗集中于最可能获益的患者亚组。
