Maor Y, Schapiro J M, Bashari D, Lurie Y, Safadi R, Segol O, Paritsky M, Rachlis Z, Avidan B, Bar-Meir S, Martinowitz U
Department of Gastroenterology and Hepatology, Sheba Medical Center Tel-Hashomer, Israel.
Haemophilia. 2008 Mar;14(2):336-42. doi: 10.1111/j.1365-2516.2007.01633.x. Epub 2008 Jan 16.
Treatment with pegylated interferon (Peg-IFN) and ribavirin, now the standard of care, has been shown to achieve sustained viral response (SVR) in up to 60% of patients with hepatitis C (HCV). Studies of response to this combination in HCV-infected haemophilia patients are scarce. The aim of the study was to report the results and safety of interferon/ribavirin treatment in HCV and HCV-/HIV-infected patients at the Israeli National Hemophilia Center. A retrospective observational cohort study was conducted on haemophilia patients infected with HCV or HCV/HIV. Patients received combination of Peg-IFN and ribavirin. Few were still treated with standard interferon. The primary end-point was sustained viral response (SVR). The secondary end-point was safety, with emphasis on increased bleeding episodes. Some 18/43 (42%) HCV mono-infected haemophilia patients achieved SVR. Relapse occurred in 14 (33%), while 11 patients (25%) were non-responders. SVR was achieved among 17/37 (46%) naïve patients receiving Peg-IFN and ribavirin. Among patients with genotype-1, SVR was achieved in 12/36 (33%) and 11/30 (37%) in the whole group and Peg-IFN treated naïve patients, respectively. In HCV/HIV co-infected patients only 1 patient achieved SVR. Severe anaemia occurred in 14/50 (28%) patients, four received erythropoietin. None maintained stable haemoglobin levels. Two patients had significant bleeding episodes. In our cohort of haemophilia patients, SVR was achieved in a lower than expected rates. A relatively high relapse rate in the HCV mono-infected patients and a very high non-response rate in the HCV/HIV co-infected patients were observed as anticipated. Anaemia was a major side effect and the use of growth factors seemed unrevealing.
聚乙二醇化干扰素（Peg-IFN）联合利巴韦林治疗目前是丙型肝炎（HCV）的标准治疗方案，已被证明在高达60%的丙型肝炎患者中可实现持续病毒学应答（SVR）。关于HCV感染的血友病患者对这种联合治疗反应的研究很少。本研究的目的是报告以色列国家血友病中心对HCV及HCV/HIV感染患者进行干扰素/利巴韦林治疗的结果和安全性。对感染HCV或HCV/HIV的血友病患者进行了一项回顾性观察队列研究。患者接受Peg-IFN和利巴韦林联合治疗。少数患者仍接受标准干扰素治疗。主要终点是持续病毒学应答（SVR）。次要终点是安全性，重点是出血事件增加。约18/43（42%）的HCV单一感染血友病患者实现了SVR。14例（33%）出现复发，11例患者（25%）无应答。在接受Peg-IFN和利巴韦林治疗的17/37（46%）初治患者中实现了SVR。在基因1型患者中，全组和接受Peg-IFN治疗的初治患者中分别有12/36（33%）和11/30（37%）实现了SVR。在HCV/HIV合并感染患者中，只有1例患者实现了SVR。14/50（28%）的患者出现严重贫血，4例接受了促红细胞生成素治疗。无人维持稳定的血红蛋白水平。2例患者发生了严重出血事件。在我们的血友病患者队列中，SVR实现率低于预期。正如预期的那样，在HCV单一感染患者中观察到相对较高的复发率，在HCV/HIV合并感染患者中观察到非常高的无应答率。贫血是主要的副作用，生长因子的使用似乎效果不佳。
