Lunel Françoise, Veillon Pascal, Fouchard-Hubert Isabelle, Loustaud-Ratti Véronique, Abergel Armand, Silvain Christine, Rifflet Hervé, Blanchi Alain, Causse Xavier, Bacq Yannick, Payan Christopher
Laboratoire de Bactériologie-Virologie, CHU Angers, Angers Cedex, France.
J Hepatol. 2003 Nov;39(5):826-33. doi: 10.1016/s0168-8278(03)00402-1.
BACKGROUND/AIMS: To evaluate the efficacy of ribavirin, given in second intention in non-responders to interferon alone, by studying viral kinetics.
We conducted a trial including 203 patients with chronic hepatitis C, naïve of treatment. Patients were treated with interferon three times a week with or without ribavirin and amantadine according to response. Viral kinetics were assessed by serial measurements of HCV RNA (bDNA 3.0 and Monitor 2.0) and a new assay, trak-C, able to quantify total Hepatitis C virus (HCV) core antigen.
A significant initial drop in HCV RNA or HCV core antigen, under interferon alone, was associated with response to therapy, -4.85+/-1.33 log for HCV RNA in sustained responders versus -1.86+/-1.53 log for others groups, P<0.001. In patients receiving ribavirin in second intention, we also observed a similar drop in HCV RNA and HCV core antigen, predictive of sustained response, -2.67+/-1.26 log for HCV RNA in sustained responders versus -0.44+/-0.49 log in non-responders, P<0.001.
Ribavirin has probably an additional antiviral effect in interferon treated patients. Kinetics of HCV RNA and HCV core antigen under treatment are highly predictive of a sustained virological response.
背景/目的：通过研究病毒动力学，评估利巴韦林对于单独使用干扰素无反应者的疗效。
我们开展了一项试验，纳入203例未经治疗的慢性丙型肝炎患者。根据反应情况，患者接受每周三次的干扰素治疗，同时或不同时使用利巴韦林及金刚烷胺。通过连续检测HCV RNA（分支DNA 3.0和监测仪2.0）以及一种能够定量总丙型肝炎病毒（HCV）核心抗原的新检测方法trak-C来评估病毒动力学。
单独使用干扰素时，HCV RNA或HCV核心抗原显著的初始下降与治疗反应相关，持续反应者的HCV RNA下降-4.85±1.33 log，其他组为-1.86±1.53 log，P<0.001。在二线接受利巴韦林治疗的患者中，我们也观察到HCV RNA和HCV核心抗原出现类似下降，这可预测持续反应，持续反应者的HCV RNA下降-2.67±1.26 log，无反应者为-0.44±0.49 log，P<0.001。
利巴韦林可能对接受干扰素治疗的患者具有额外的抗病毒作用。治疗期间HCV RNA和HCV核心抗原的动力学高度预测持续病毒学反应。
