Department of Surgical and Gastroenterological Sciences, University of Padua, Padua, Italy.
Infection. 2012 Apr;40(2):173-9. doi: 10.1007/s15010-011-0219-0. Epub 2011 Nov 18.
Pegylated interferon (PEG-IFN) and ribavirin is the most effective treatment for chronic hepatitis C virus (HCV) hepatitis, but the rate of sustained virological response (SVR) remains approximately 50%, and 15-20% of all treated patients have a virological relapse after completing the treatment. Studies on the SVR have failed to discriminate between non-responders and relapsers.
To identify the risk factors for relapse among patients with an end-of-treatment response (ETR).
We retrospectively analyzed 281 patients consecutively treated with PEG-IFN and ribavirin with a follow-up period of at least 24 weeks. The baseline details collected on each patient included demographic data, histological features, and biochemical profiles.
Forty-six patients (16.4%) relapsed during the first 6 months of follow-up after discontinuing the therapy. Relapser patients were significantly older, had more steatosis, fibrosis, and showed significantly lower rapid virological response (RVR) rates compared with SVR patients. By logistic regression analysis, only the absence of RVR was found to be significantly associated with relapses in both subgroups of patients with genotypes 1 and 4 (p < 0.004) and those with genotypes 2 and 3 (p < 0.006). Severe fibrosis was also predictive of relapsing disease, but only for genotypes 2 and 3 patients (p < 0.003). During the treatment, serum HCV-RNA decreased more rapidly in patients with SVR compared to non-responder and relapser patients (p < 0.001). Interestingly, relapser patients exhibited an intermediate serum HCV-RNA decay during the first 4 weeks of therapy.
Among HCV patients treated with PEG-IFN and ribavirin, the absence of RVR was the most important independent predictor of relapse, independent of the HCV genotype. In the subgroup of genotypes 2 and 3 patients, the severity of fibrosis was also an important factor associated with the relapse rate.
聚乙二醇干扰素（PEG-IFN）和利巴韦林是治疗慢性丙型肝炎病毒（HCV）肝炎最有效的方法，但持续病毒学应答（SVR）率仍约为 50%，所有接受治疗的患者中有 15-20%在完成治疗后出现病毒学复发。对 SVR 的研究未能区分无应答者和复发者。
确定治疗结束时应答（ETR）患者复发的危险因素。
我们回顾性分析了 281 例连续接受 PEG-IFN 和利巴韦林治疗的患者，随访时间至少 24 周。每位患者的基线详细信息包括人口统计学数据、组织学特征和生化特征。
46 例患者（16.4%）在停止治疗后的前 6 个月随访期间复发。与 SVR 患者相比，复发患者年龄较大，脂肪变性、纤维化程度更高，快速病毒学应答（RVR）率明显较低。通过逻辑回归分析，仅 RVR 缺失与基因型 1 和 4 患者（p < 0.004）和基因型 2 和 3 患者（p < 0.006）的复发均显著相关。严重纤维化也是复发性疾病的预测因素，但仅适用于基因型 2 和 3 患者（p < 0.003）。在治疗期间，与非应答者和复发者相比，SVR 患者的血清 HCV-RNA 下降更快（p < 0.001）。有趣的是，复发者在治疗的前 4 周内表现出中间的血清 HCV-RNA 衰减。
在接受 PEG-IFN 和利巴韦林治疗的 HCV 患者中，RVR 缺失是复发的最重要独立预测因素，与 HCV 基因型无关。在基因型 2 和 3 患者亚组中，纤维化的严重程度也是与复发率相关的重要因素。
