Baiocchi Leonardo, De Leonardis Francesco, Delle Monache Marco, Nosotti Lorenzo, Conti Renato L, Lenci Ilaria, Carbone Marco, Di Paolo Daniele, Cucchiarelli Silvia, Angelico Mario
Hepatology Unit, University of Rome, Rome, Italy.
Antivir Ther. 2010;15(4):633-9. doi: 10.3851/IMP1560.
On-treatment predictors during antiviral therapy of HCV are useful because they allow discontinuation of an unnecessary treatment in non-responders. Our aim was to evaluate the usefulness of plasma and erythrocyte ribavirin levels in predicting sustained virological response (SVR) in HCV genotype 1 patients undergoing antiviral treatment.
A total of 40 HCV genotype 1 patients treated with pegylated interferon-alpha2a 180 microg weekly plus ribavirin 1,000 or 1,200 mg daily (according to body weight) were included in the study. Plasma and erythrocyte ribavirin levels were evaluated in all patients at week 12 by HPLC. At week 24, ribavirin levels were reassessed in those achieving early virological response (EVR).
A total of 27 patients achieved EVR, whereas 17 achieved SVR. There was no difference among EVR and non-EVR patients in terms of plasma and erythrocyte ribavirin concentrations at week 12. At week 24, EVR patients obtaining SVR exhibited higher mean +/-sd levels of ribavirin in plasma and lower levels in erythrocytes compared with non-SVR patients (in plasma 12.8 +/-10 versus 5.8 +/-4 microM [P<0.02] and in erythrocytes 1,053 +/-504 versus 1,613 +/-589 microM [P<0.03]). When the plasma ribavirin/erythrocyte ribavirin x100 ratio was compared, the difference was enhanced (1.5 +/-1.3 versus 0.4 +/-0.3 microM; P<0.01). Receiver operating characteristic curve analysis identified a cutoff for plasma ribavirin/erythrocyte ribavirin x100 ratio in predicting SVR of 0.71 with a negative predictive value of 0.8 and a positive predictive value of 0.9, whereas those related to EVR were 1 and 0.6, respectively.
Plasma ribavirin/erythrocyte ribavirin x100 ratio at week 24 seems to be a good indicator of SVR in HCV genotype 1 patients achieving EVR.
丙型肝炎病毒（HCV）抗病毒治疗期间的治疗期预测指标很有用，因为它们能让无应答者停止不必要的治疗。我们的目的是评估血浆和红细胞中利巴韦林水平对接受抗病毒治疗的HCV 1型患者持续病毒学应答（SVR）的预测价值。
本研究共纳入40例接受聚乙二醇化干扰素-α2a（每周180μg）联合利巴韦林（根据体重每天1000或1200mg）治疗的HCV 1型患者。在第12周时，通过高效液相色谱法（HPLC）评估所有患者血浆和红细胞中的利巴韦林水平。在第24周时，对实现早期病毒学应答（EVR）的患者重新评估利巴韦林水平。
共有27例患者实现EVR，17例实现SVR。在第12周时，EVR患者和未实现EVR的患者在血浆和红细胞利巴韦林浓度方面没有差异。在第24周时，实现SVR的EVR患者与未实现SVR的患者相比，血浆中利巴韦林的平均水平更高（±标准差，12.8±10对5.8±4μM [P<0.02]），红细胞中利巴韦林水平更低（1053±504对1613±589μM [P<0.03]）。比较血浆利巴韦林/红细胞利巴韦林×100的比值时，差异更为明显（1.5±1.3对0.4±0.3μM；P<0.01）。受试者工作特征曲线分析确定，血浆利巴韦林/红细胞利巴韦林×100比值预测SVR的截断值为0.71，阴性预测值为0.8，阳性预测值为0.9，而预测EVR的截断值分别为1和0.6。
对于实现EVR的HCV 1型患者，第24周时的血浆利巴韦林/红细胞利巴韦林×100比值似乎是SVR的良好指标。
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