Liu Chun-Jen, Chuang Wan-Long, Lee Chuan-Mo, Yu Ming-Lung, Lu Sheng-Nan, Wu Shun-Sheng, Liao Li-Ying, Chen Chi-Ling, Kuo Hsing-Tao, Chao You-Chen, Tung Shui-Yi, Yang Sien-Sing, Kao Jia-Horng, Liu Chen-Hua, Su Wei-Wen, Lin Chih-Lin, Jeng Yung-Ming, Chen Pei-Jer, Chen Ding-Shinn
National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Gastroenterology. 2009 Feb;136(2):496-504.e3. doi: 10.1053/j.gastro.2008.10.049. Epub 2008 Oct 29.
BACKGROUND & AIMS: Dual chronic infection with hepatitis C virus (HCV) and hepatitis B virus (HBV) is common in areas endemic for either virus. Combination therapy with ribavirin and pegylated interferon (peginterferon) is the standard of care for patients with HCV monoinfection. We investigated the effects of combination therapy in patients infected with both HBV and HCV (genotypes 1, 2, or 3).
The study included 321 Taiwanese patients with active HCV infection; 161 also tested positive for hepatitis B surface antigen (HBsAg) and 160 were HBsAg-negative (controls). Patients with HCV genotype 1 infection received peginterferon alfa-2a (180 mug) weekly for 48 weeks and ribavirin (1000-1200 mg) daily. Patients with HCV genotypes 2 or 3 received peginterferon alfa-2a weekly for 24 weeks and ribavirin (800 mg) daily. At 24 weeks posttreatment, patient samples were examined for a sustained virologic response (SVR) against HCV (serum HCV levels decreased to <25 IU/mL).
In patients with HCV genotype 1 infection, the SVR was 72.2% in dually infected patients vs 77.3% in monoinfected patients after treatment. For patients with HCV genotype 2/3 infections, the SVR values were 82.8% and 84.0%, respectively, after treatment. Serum HBV DNA eventually appeared in 36.3% of 77 dual-infected patients with undetectable pretreatment levels of HBV DNA; this was not accompanied by significant hepatitis. Posttreatment HBsAg clearance was observed in 11.2% of 161 dual-infected patients.
Combination therapy with peginterferon alfa-2a and ribavirin is equally effective in patients with HCV monoinfection and in those with dual chronic HCV/HBV infection.
丙型肝炎病毒（HCV）和乙型肝炎病毒（HBV）的双重慢性感染在这两种病毒的地方性流行地区很常见。利巴韦林与聚乙二醇化干扰素（聚乙二醇干扰素）联合治疗是HCV单一感染患者的标准治疗方法。我们研究了联合治疗对同时感染HBV和HCV（1、2或3型）患者的影响。
该研究纳入了321名台湾活动性HCV感染患者；其中161名乙型肝炎表面抗原（HBsAg）检测也呈阳性，160名HBsAg阴性（对照组）。HCV 1型感染患者接受聚乙二醇化干扰素α-2a（180μg）每周1次，共48周，以及利巴韦林（1000 - 1200mg）每日1次。HCV 2或3型感染患者接受聚乙二醇化干扰素α-2a每周1次，共24周，以及利巴韦林（800mg）每日1次。治疗后24周，检测患者样本以评估针对HCV的持续病毒学应答（SVR，血清HCV水平降至<25 IU/mL）。
在HCV 1型感染患者中，双重感染患者治疗后的SVR为72.2%，单一感染患者为77.3%。对于HCV 2/3型感染患者，治疗后的SVR值分别为82.8%和84.0%。77名治疗前HBV DNA水平不可测的双重感染患者中，最终有36.3%的患者血清HBV DNA出现；这并未伴有明显肝炎。161名双重感染患者中有11.2%在治疗后出现HBsAg清除。
聚乙二醇化干扰素α-2a与利巴韦林联合治疗对HCV单一感染患者和慢性HCV/HBV双重感染患者同样有效。
