Michael E. DeBakey VA Medical Center, Houston, TX, United States.
J Hepatol. 2012 Feb;56(2):320-5. doi: 10.1016/j.jhep.2011.05.032. Epub 2011 Jul 12.
BACKGROUND & AIMS: Antiviral treatment for hepatitis C virus (HCV) has high efficacy rates for achieving sustained viral response (SVR) in randomized controlled trials (RCTs) (40-80%); however, it can be lower in community-based practice settings. We wanted to determine the effectiveness of HCV treatment in Veterans Administration (VA) hospitals nationwide.
Using the nationwide VA HCV Clinical Case Registry (CCR), we examined a cohort of veterans who had HCV viremia between 2000 and 2005 and identified patients who received pegylated-interferon (PEG-INF) and ribavirin. The duration of treatment and proportion of patients completing treatment was calculated. The effectiveness of treatment was measured as the proportion of patients who achieved SVR (negative viremia at least 12 weeks after the end of treatment) in the entire cohort, and among patients who initiated and completed treatment.
We identified 99,166 patients with HCV viremia. Of those, 11.6% received PEG-INF with ribavirin and 6.4% completed treatment. Contraindications were present in 57.2% of the patients that did not receive treatment. SVR was documented in 39.9% and 58.3% of patients who completed treatment; 23.6% and 50.6% of patients who initiated treatment; and 3.9% and 11.2% of the entire HCV cohort for genotype 1 or 4 and 2 or 3, respectively. Overall, only 3.5% of the entire HCV viremic cohort had a documented SVR.
Treatment effectiveness for HCV is low. In addition to fixed factors, such as race and virus genotype, the drop in effectiveness is due to low rates of antiviral treatment initiation and treatment completion.
在随机对照试验（RCT）中，抗病毒治疗丙型肝炎病毒（HCV）的持续病毒学应答（SVR）率很高（40-80%）；然而，在社区实践环境中可能较低。我们想确定全国退伍军人事务部（VA）医院 HCV 治疗的效果。
我们使用全国 VA HCV 临床病例登记处（CCR），检查了一组在 2000 年至 2005 年间患有 HCV 病毒血症的退伍军人，并确定了接受聚乙二醇干扰素（PEG-INF）和利巴韦林治疗的患者。计算了治疗的持续时间和完成治疗的患者比例。治疗效果通过整个队列中实现 SVR（治疗结束后至少 12 周病毒阴性）的患者比例以及开始和完成治疗的患者比例来衡量。
我们确定了 99166 例 HCV 病毒血症患者。其中，11.6%接受 PEG-INF 联合利巴韦林治疗，6.4%完成治疗。未接受治疗的患者中有 57.2%存在禁忌症。完成治疗的患者中，SVR 记录在案的比例分别为 39.9%和 58.3%；开始治疗的患者分别为 23.6%和 50.6%；基因型 1 或 4 和 2 或 3 的整个 HCV 队列分别为 3.9%和 11.2%。总的来说，只有 3.5%的整个 HCV 病毒血症患者有记录的 SVR。
HCV 的治疗效果较低。除了种族和病毒基因型等固定因素外，治疗效果下降还归因于抗病毒治疗开始和完成率低。
