Akhan Sila Cetin, Gurel Erdem, Sayan Murat
Kocaeli Univaersity Medical Faculty, Infectious Diseases anc Clinical Microbiology, Kocaeli, Turkey.
Indian J Pathol Microbiol. 2011 Jan-Mar;54(1):81-4. doi: 10.4103/0377-4929.77330.
Pegylated interferon and ribavirin combination therapy remain the first-line treatment for chronic hepatitis C virus (HCV) infection. In contrast to the large number of studies in treatment-naive patients, the effectiveness of retreatment in patients who have previously failed pegylated interferon based therapy is not much reported.
The aim of this retrospective study was to focus on the efficacy of pegylated interferon alpha and ribavirin in retreated chronic hepatitis C patients.
All patients were treated with pegylated interferon alpha either 2a (180 μg) or 2b (1.5μg/kg) subcutaneously once weekly for a 48-week period, plus ribavirin 1000-1200 mg/day. The patient who had a negative HCV RNA at the end of 48 weeks were followed up for 24 weeks, and the patients who relapsed in the post-treatment follow-up period of 24 weeks were treated again with pegylated interferon alpha; but if the first treatment was administered with pegylated interferon alpha 2a, the second was administered with pegylated interferon alpha 2b and if pegylated interferon alpha 2b, then the second with pegylated interferon alpha 2a.
We evaluated the outcome of our patients with chronic HCV who achieved a viral response at the end of the therapy, but did not achieve sustained virologic response; 54% (38/70) of patients did achieve sustained virologic response, while 46% (32/70) of patients did not (eight patients did not achieve early virologic response, five patients were nonresponders at 24th week of the treatment, the remaining 19 patient had negative HCV at the end of the therapy but did not achieve sustained virologic response). We began from 19 patients to 8 patients, who had negative HCV RNA at the end of the treatment, but did not achieve sustained virologic response, interferon plus ribavirin therapy again. If the patient had interferon alpha 2a, we gave in the second tour alpha 2b; and if alpha 2b, then alpha 2a. The early virologic response of these nine patients were found to be 63% (5/8). These 5 patients who had rapid virologic response and early virologic response at the second therapy achieved sustained virologic response this time.
These findings suggest that the standard 48-week treatment is insufficient and that an extended course of treatment may be necessary. Relapse is a poorly understood clinical outcome in the treatment of chronic HCV patients. Retreatment can give a chance to some patients specially who have early virologic response and negative HCV RNA at the end of the first therapy.
聚乙二醇化干扰素和利巴韦林联合疗法仍是慢性丙型肝炎病毒（HCV）感染的一线治疗方法。与大量针对初治患者的研究相比，此前基于聚乙二醇化干扰素治疗失败的患者再次治疗的有效性报道较少。
这项回顾性研究的目的是聚焦聚乙二醇化干扰素α和利巴韦林在再次治疗的慢性丙型肝炎患者中的疗效。
所有患者接受聚乙二醇化干扰素α 2a（180μg）或2b（1.5μg/kg）皮下注射，每周1次，共48周，加用利巴韦林1000 - 1200mg/天。在48周结束时HCV RNA阴性的患者随访24周，在24周的治疗后随访期复发的患者再次接受聚乙二醇化干扰素α治疗；但如果首次治疗使用的是聚乙二醇化干扰素α 2a，则第二次使用聚乙二醇化干扰素α 2b，如果首次使用的是聚乙二醇化干扰素α 2b，则第二次使用聚乙二醇化干扰素α 2a。
我们评估了慢性HCV患者在治疗结束时获得病毒学应答但未获得持续病毒学应答的结果；54%（38/70）的患者确实获得了持续病毒学应答，而46%（32/70）的患者未获得（8例患者未获得早期病毒学应答，5例患者在治疗第24周时无应答，其余19例患者在治疗结束时HCV为阴性但未获得持续病毒学应答）。我们从19例在治疗结束时HCV RNA阴性但未获得持续病毒学应答的患者开始，再次给予干扰素加利巴韦林治疗。如果患者首次使用的是干扰素α 2a，第二次则给予α 2b；如果首次使用的是α 2b，则第二次给予α 2a。这9例患者的早期病毒学应答率为63%（5/8）。这5例在第二次治疗时具有快速病毒学应答和早期病毒学应答的患者此次获得了持续病毒学应答。
这些发现表明标准的48周治疗并不充分，可能需要延长疗程。复发是慢性HCV患者治疗中一个了解较少的临床结局。再次治疗可以给一些患者，特别是那些在首次治疗结束时具有早期病毒学应答且HCV RNA阴性的患者一个机会。
