Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA.
Am J Gastroenterol. 2010 May;105(5):1110-5. doi: 10.1038/ajg.2009.635. Epub 2009 Nov 10.
Previous studies have found ethnicity to be an important predictor of outcomes of treatment with peginterferon (PEG-IFN) and ribavirin (RBV) in chronic hepatitis C. Although the expected sustained virological response (SVR) rates of Hispanics and African Americans are lower than those of Caucasians, SVR rates in Asians appear to be more favorable. However, in some of these studies, hepatitis C virus (HCV) genotype was identified by INNO-LiPA assay, which can mistype the easier-to-treat HCV genotype 6 as genotype 1. Our goal was to compare SVR rates among Caucasian and Asian-American patients with genotype 1 and 2/3 infection whose HCV genotypes were accurately classified by core sequencing testing.
A cohort of 269 consecutive treatment-naive HCV-infected patients with genotype 1 or 2/3 (157 Caucasians and 112 Asians) treated with PEG-IFN+RBV from January 2001 to November 2007 at four community-based gastroenterology clinics in Northern California were studied. The analysis of data was by intention-to-treat.
The SVR rates for patients with genotype 1 were 45% for Caucasians and 52% for Asians (P=0.37). The SVR rates for patients with genotype 2/3 infection was 77% for Asians and 74% for Caucasians (P=0.7). On multivariate logistic regression analyses adjusting for age, alanine aminotransferase (ALT), baseline viral load, HCV genotype, and treatment adherence, we did not find Asian ethnicity to predict SVR. On a separate analysis, we found that Asians who had HCV genotype 1 or 1b by the less accurate INNO-LiPA assay had significantly higher SVR rates than Caucasians with genotype 1 (64% vs. 45%, respectively, P=0.03).
SVR rates were similar in Asian Americans and Caucasians infected with HCV genotype 1 or 2/3 when HCV genotype classification was accurately determined.
先前的研究发现，在慢性丙型肝炎患者接受聚乙二醇干扰素（PEG-IFN）和利巴韦林（RBV）治疗中，种族是一个重要的疗效预测因素。尽管西班牙裔和非裔美国人的预期持续病毒学应答（SVR）率低于白种人，但亚洲人的 SVR 率似乎更为有利。然而，在这些研究中的一些研究中，丙型肝炎病毒（HCV）基因型是通过 INNO-LiPA 检测来鉴定的，该检测可能会将较易治疗的 HCV 基因型 6 误诊为基因型 1。我们的目标是比较接受 PEG-IFN+RBV 治疗的基因型 1 和 2/3 感染的白种人和亚裔美国人患者的 SVR 率，这些患者的 HCV 基因型是通过核心测序检测准确分类的。
我们研究了 2001 年 1 月至 2007 年 11 月在加利福尼亚州北部四家社区胃肠病学诊所接受 PEG-IFN+RBV 治疗的 269 例连续治疗初治的 HCV 感染患者的队列，这些患者的基因型为 1 或 2/3（157 名白种人和 112 名亚裔）。数据的分析是基于意向治疗。
基因型 1 患者的 SVR 率为白种人 45%，亚裔 52%（P=0.37）。基因型 2/3 感染患者的 SVR 率为亚洲人 77%，白种人 74%（P=0.7）。在调整年龄、丙氨酸氨基转移酶（ALT）、基线病毒载量、HCV 基因型和治疗依从性的多变量逻辑回归分析中，我们没有发现亚洲种族能预测 SVR。在单独的分析中，我们发现，通过不太准确的 INNO-LiPA 检测被鉴定为 HCV 基因型 1 或 1b 的亚洲人，其 SVR 率明显高于基因型 1 的白种人（分别为 64%和 45%，P=0.03）。
当 HCV 基因型分类准确确定时，亚裔美国人与白种人感染 HCV 基因型 1 或 2/3 的 SVR 率相似。
