接受干扰素联合利巴韦林治疗的HIV/HCV合并感染患者的严重体重减轻：发生率及危险因素。

Severe weight loss in HIV / HCV-coinfected patients treated with interferon plus ribavirin: incidence and risk factors.

作者信息

Bani-Sadr F, Lapidus N, Melchior J-C, Ravaux I, Bensalem M, Rosa I, Cacoub P, Pol S, Perronne C, Carrat F

机构信息

Groupe Hospitalier Universitaire Est, Université Paris 6, INSERM U707, Paris, France.

出版信息

J Viral Hepat. 2008 Apr;15(4):255-60. doi: 10.1111/j.1365-2893.2007.00939.x.

DOI:10.1111/j.1365-2893.2007.00939.x

PMID:18307589

Abstract

Weight loss is reported by more than 20% of hepatitis C virus (HCV)-monoinfected patients treated with the peg-interferon (peg-IFN) and ribavirin combination. The aim of this study was to determine the incidence and risk factors of severe weight loss (> or =10%) in human immunodeficiency virus (HIV) / HCV-coinfected patients participating in a randomized, controlled 48-week trial comparing peg-IFN alpha 2b plus ribavirin with IFN alpha-2b plus ribavirin. Univariate and multivariate analyses were used to identify links with antiretroviral treatments, anti-HCV therapy and clinical and laboratory findings. One hundred eleven (28.9%) of 383 patients who received at least one dose of anti-HCV treatment subsequently had severe weight loss. Among patients who took at least 80% of the planned total dose, severe weight loss occurred in 74 patients (32.7%). In multivariate analysis, age >40 years [hazard ratio (HR), 1.59; 95% CI 1.09 to 2.31; P = 0.016], body mass index (BMI) >22 (HR, 1.72; 95% CI, 1.16 to 2.55; P = 0.0069), peg-IFN alpha-2b (HR, 1.82; 95% CI, 1.24 to 2.69; P = 0.0022) and female sex (HR, 1.60; 95% CI, 1.05 to 2.43; P = 0.027) were associated with severe weight loss. In contrast, patients taking non-nucleoside reverse transcriptase inhibitors (NNRTI)-containing antiretroviral regimens were less likely to lose weight (HR, 0.62; 95% CI, 0.39 to 0.96; P = 0.034). Lipodystrophy tended to occur more frequently in patients who had severe weight loss than in the other patients (26.1%vs 17.6%; P = 0.0682) and patients whose weight loss >5% persisted 24 weeks after the completion of anti-HCV therapy (n = 58 / 111) were more likely to be receiving stavudine-based antiretroviral therapy, suggesting that mitochondrial toxicity plays some role in weight loss. These findings show that severe weight loss is a frequent side effect of anti-HCV therapy in HIV / HCV-coinfected patients. The underlying mechanisms remain to be identified.

摘要

超过20%接受聚乙二醇干扰素（peg-IFN）和利巴韦林联合治疗的丙型肝炎病毒（HCV）单感染患者报告有体重减轻。本研究的目的是确定参与一项随机对照48周试验的人类免疫缺陷病毒（HIV）/HCV合并感染患者中严重体重减轻（≥10%）的发生率和危险因素，该试验比较了聚乙二醇干扰素α-2b加利巴韦林与干扰素α-2b加利巴韦林。采用单因素和多因素分析来确定与抗逆转录病毒治疗、抗HCV治疗以及临床和实验室检查结果之间的联系。383例接受至少一剂抗HCV治疗的患者中，有111例（28.9%）随后出现严重体重减轻。在至少服用了计划总剂量80%的患者中，74例（32.7%）出现严重体重减轻。多因素分析显示，年龄>40岁[风险比（HR），1.59；95%可信区间（CI）1.09至2.31；P = 0.016]、体重指数（BMI）>22（HR，1.72；95%CI，1.16至2.55；P = 0.0069）、聚乙二醇干扰素α-2b（HR，1.82；95%CI，1.24至2.69；P = 0.0022）和女性（HR，1.60；95%CI，1.05至2.43；P = 0.027）与严重体重减轻相关。相比之下，接受含非核苷类逆转录酶抑制剂（NNRTI）抗逆转录病毒方案的患者体重减轻的可能性较小（HR，0.62；95%CI，0.39至0.96；P = 0.034）。与其他患者相比，严重体重减轻的患者脂肪代谢障碍的发生率往往更高（26.1%对17.6%；P = 0.0682），并且在抗HCV治疗完成后体重减轻>5%持续24周的患者（n = 58 / 111）更有可能接受基于司他夫定的抗逆转录病毒治疗，这表明线粒体毒性在体重减轻中起了一定作用。这些发现表明，严重体重减轻是HIV/HCV合并感染患者抗HCV治疗常见的副作用。其潜在机制仍有待确定。