Backus Lisa I, Boothroyd Derek B, Phillips Barbara R, Mole Larry A
Center for Quality Management in Public Health, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
Hepatology. 2007 Jul;46(1):37-47. doi: 10.1002/hep.21662.
The currently recommended treatment for hepatitis C virus (HCV) infection is pegylated interferon alfa (PEG-INF) and ribavirin, which can be difficult to tolerate. More information about predicting sustained virologic response (SVR) may allow more informed treatment decisions to be made. This retrospective observational cohort study identified predictors of SVR to PEG-INF and ribavirin in routine medical practice at 121 Department of Veterans Affairs facilities. Among 5,944 patients infected with HCV genotypes 1, 2, or 3 who had been treated with PEG-INF and ribavirin, SVR rates were 20%, 52%, and 43%, respectively, and discontinuation rates were 68% (prior to 48 weeks), 34% (24 weeks), and 41% (24 weeks), respectively. In multivariate analysis, significant predictors of decreased likelihood of genotype 1 patients having an SVR were being African American, clinical liver disease, diabetes, low cholesterol, low hemoglobin, low platelet count, and treatment at a low-volume facility. Predictors of increased likelihood of genotype 1 patients having an SVR were low-level HCV viremia, elevated ALT quotient, and receiving PEG-INF 2A (rather than 2B). For genotype 2 patients, increasing body mass index, prior use of interferon, and low platelet count were negative predictors; only low-level HCV viremia was a positive predictor. For genotype 3 patients, only receiving PEG-INF 2A affected the likelihood of an SVR; its effect was positive.
Among patients for whom HCV treatment is initiated during routine medical care, multiple factors including form of PEG-INF received affect the SVR rate for genotype 1 patients. Few of these factors affect the rate for genotype 2 patients, and even fewer do so for genotype 3 patients.
目前推荐的丙型肝炎病毒（HCV）感染治疗方法是聚乙二醇化干扰素α（PEG-INF）和利巴韦林，但这种治疗可能难以耐受。更多关于预测持续病毒学应答（SVR）的信息可能有助于做出更明智的治疗决策。这项回顾性观察队列研究确定了在121家退伍军人事务部医疗机构的常规医疗实践中，PEG-INF和利巴韦林治疗SVR的预测因素。在5944例感染HCV 1、2或3型且接受过PEG-INF和利巴韦林治疗的患者中，SVR率分别为20%、52%和43%，停药率分别为68%（48周前）、34%（24周）和41%（24周）。多因素分析显示，1型患者SVR可能性降低的显著预测因素包括非裔美国人、临床肝病、糖尿病、低胆固醇、低血红蛋白、低血小板计数以及在低容量医疗机构接受治疗。1型患者SVR可能性增加的预测因素包括低水平HCV病毒血症、升高的ALT商以及接受PEG-INF 2A（而非2B）。对于2型患者，体重指数增加、既往使用干扰素以及低血小板计数是负性预测因素；只有低水平HCV病毒血症是正性预测因素。对于3型患者，只有接受PEG-INF 2A影响SVR可能性；其影响是正性的。
在常规医疗护理期间开始进行HCV治疗的患者中，包括所接受的PEG-INF形式在内的多种因素影响1型患者的SVR率。这些因素中很少影响2型患者的SVR率，对3型患者的影响更少。
