Núñez Marina, Mariño Ana, Miralles Celia, Berdún Miguel A, Sola Julio, Hernandez-Burruezo Juan Jose, Galindo Maria Jose, Barreiro Pablo, Martin-Carbonero Luz, Soriano Vincent
Department of Infectious Diseases. Hospital Carlos III, Calle Sinesio Delgado 10, 28029 Madrid, Spain.
J Acquir Immune Defic Syndr. 2007 Aug 1;45(4):439-44. doi: 10.1097/QAI.0b013e318061b5d9.
Relapse after achieving virologic response to anti-hepatitis C virus (HCV) treatment considerably reduces sustained virologic response rates. It is unclear what the main predictors of relapse in HCV/HIV-coinfected patients are.
The Pegasys Ribavirina España Coinfección (PRESCO) study evaluated short and extended duration of treatment for chronic hepatitis C using pegylated interferon (peg-IFN)-alpha2a at a dose of 180 microg/wk plus weight-based ribavirin (RBV) at a dose of 1000 to 1200 mg/d in HIV-infected subjects. Patients with HCV-2/3 were treated for 6 or 12 months, and patients with HCV-1/4 were treated for 12 or 18 months.
Of 389 patients included in the trial, end-of-treatment response was achieved by 262 (67.3%): 106 with HCV-1 (55%), 137 with HCV-2/3 (90%), and 19 with HCV-4 (41%). Six patients were lost to follow-up after completing therapy. Of the remaining 256 patients, 62 (24%) relapsed: 33% of HCV-1 patients, 18% of HCV-2/3 patients, and 21% of HCV-4 patients. In multivariate logistic regression analysis, baseline serum HCV RNA level > or =500,000 IU/mL (relative risk [RR] = 4.81, 95% confidence interval [CI]: 1.52 to 15.22; P = 0.008) and lack of rapid virologic response, defined as undetectable HCV RNA level at week 4 (RR = 2.94, 95% CI: 1.22 to 7.09; P = 0.02) were the best independent predictors of HCV relapse. Use of concomitant antiretroviral therapy also predicted relapse (P = 0.04), and a trend toward a higher relapse rate was recognized for HCV genotypes 1 and 4 versus genotypes 2 and 3 (P = 0.08). Extended treatment did not result in a lower incidence of relapse, at least for HCV genotypes 2 and 3.
High baseline serum HCV RNA level and lack of undetectable viremia at week 4 are the most significant predictors of relapse in HCV/HIV-coinfected patients treated with peg-IFN plus weight-based RBV.
在抗丙型肝炎病毒（HCV）治疗中实现病毒学应答后复发会显著降低持续病毒学应答率。目前尚不清楚HCV/HIV合并感染患者复发的主要预测因素是什么。
聚乙二醇化干扰素α-2a联合利巴韦林西班牙合并感染研究（PRESCO）评估了在HIV感染受试者中使用剂量为180μg/周的聚乙二醇化干扰素（peg-IFN）-α2a加基于体重的剂量为1000至1200mg/d的利巴韦林（RBV）进行慢性丙型肝炎短期和延长疗程治疗的效果。HCV-2/3型患者治疗6或12个月，HCV-1/4型患者治疗12或18个月。
在纳入试验的389例患者中，262例（67.3%）实现了治疗结束时的应答：106例HCV-1型患者（55%），137例HCV-2/3型患者（90%），19例HCV-4型患者（41%）。6例患者在完成治疗后失访。在其余256例患者中，62例（24%）复发：HCV-1型患者中33%复发，HCV-2/3型患者中18%复发，HCV-4型患者中21%复发。在多因素逻辑回归分析中，基线血清HCV RNA水平≥500,000 IU/mL（相对危险度[RR]=4.81，95%置信区间[CI]：1.52至15.22；P=0.008）以及缺乏快速病毒学应答（定义为第4周时HCV RNA水平不可检测）（RR=2.94，95%CI：1.22至7.09；P=0.02）是HCV复发的最佳独立预测因素。同时使用抗逆转录病毒疗法也可预测复发（P=0.04），并且与HCV 2型和3型相比，HCV 1型和4型的复发率有升高趋势（P=0.08）。延长治疗并未降低复发率，至少对于HCV 2型和3型患者是如此。
高基线血清HCV RNA水平以及第4周时未检测到病毒血症是接受peg-IFN加基于体重的RBV治疗的HCV/HIV合并感染患者复发的最显著预测因素。
