Reiberger T, Rasoul-Rockenschaub S, Rieger A, Ferenci P, Gangl A, Peck-Radosavljevic M
Department of Gastroenterology & Hepatology, University of Vienna, Vienna, Austria.
Eur J Clin Invest. 2008 Jun;38(6):421-9. doi: 10.1111/j.1365-2362.2008.01958.x.
Interferon (IFN)-based antiviral therapy is increasingly used in immunocompromised patients with chronic hepatitis C after orthotopic liver transplantation (OLT) and HIV-HCV co-infection. Differences in early viral kinetics have not been compared in these patients.
We retrospectively analysed 76 patients (31 OLT, 20 HIV-HCV and 25 HCV control patients) undergoing IFN sensitivity testing before starting antiviral therapy with pegylated IFN-alpha 2a (180 microg week(-1)) plus ribavirin (0.8-1.2 g day(-1)) for 48 weeks. We compared baseline parameters, response to IFN and treatment outcome between the groups and assessed the influence of specific calcineurin inhibitors in OLT patients and immune status in HIV-HCV patients on treatment response.
Viral loads pretherapy were higher in OLT compared to nontransplanted HCV controls (P = 0.003). The same trend was present in HIV-HCV (P = 0.09). The log-drop after test dose was less in OLT compared to HCV (P = 0.02), while no significant difference was found between HIV-HCV and HCV. In HIV-HCV patients viral load log-drop correlated significantly with CD4(+) cell counts (P = 0.001). No difference in viral load pretherapy, log-drop and treatment outcome was noted between different calcineurin inhibitors in OLT patients. Sustained virological response rates were 28% in OLT, 50% in HIV-HCV and 56% in HCV patients.
Immunosuppression results in high HCV viral loads. Initial efficacy of IFN is significantly impaired in OLT patients, but not in HIV-HCV with largely preserved CD4(+) cell counts. Sustained virological response rates of 28% in OLT patients are suboptimal, but encouraging results are shown for HIV-HCV patients with relatively high CD4(+) cell counts.
基于干扰素（IFN）的抗病毒治疗越来越多地用于原位肝移植（OLT）后患有慢性丙型肝炎的免疫功能低下患者以及HIV-HCV合并感染患者。尚未对这些患者的早期病毒动力学差异进行比较。
我们回顾性分析了76例患者（31例OLT患者、20例HIV-HCV患者和25例HCV对照患者），这些患者在开始使用聚乙二醇化干扰素-α 2a（180μg/周(-1)）加利巴韦林（0.8-1.2g/天(-1)）进行48周抗病毒治疗前接受了IFN敏感性测试。我们比较了各组之间的基线参数、对IFN的反应和治疗结果，并评估了OLT患者中特定钙调神经磷酸酶抑制剂以及HIV-HCV患者的免疫状态对治疗反应的影响。
与未移植的HCV对照患者相比，OLT患者治疗前的病毒载量更高（P = 0.003）。HIV-HCV患者中也存在相同趋势（P = 0.09）。与HCV患者相比，OLT患者试验剂量后的对数下降幅度较小（P = 0.02），而HIV-HCV患者与HCV患者之间未发现显著差异。在HIV-HCV患者中，病毒载量对数下降与CD4(+)细胞计数显著相关（P = 0.001）。在OLT患者中，不同钙调神经磷酸酶抑制剂之间在治疗前病毒载量、对数下降和治疗结果方面未发现差异。OLT患者的持续病毒学应答率为28%，HIV-HCV患者为50%，HCV患者为56%。
免疫抑制导致HCV病毒载量升高。IFN的初始疗效在OLT患者中显著受损，但在CD4(+)细胞计数基本保留的HIV-HCV患者中未受损。OLT患者28%的持续病毒学应答率并不理想，但CD4(+)细胞计数相对较高的HIV-HCV患者显示出令人鼓舞的结果。
