Médecins Sans Frontières, 78 rue de Lausanne, 1211 Geneva, Switzerland.
Bull World Health Organ. 2012 Jul 1;90(7):540-50. doi: 10.2471/BLT.11.097147. Epub 2012 Feb 3.
To assess the effectiveness of treatment for hepatitis C virus (HCV) infection in low- and middle-income countries and identify factors associated with successful outcomes.
We performed a systematic review and meta-analysis of studies of HCV treatment programmes in low- and middle-income countries. The primary outcome was a sustained virological response (SVR). Factors associated with treatment outcomes were identified by random-effects meta-regression analysis.
The analysis involved data on 12 213 patients included in 93 studies from 17 countries. The overall SVR rate was 52% (95% confidence interval, CI: 48-56). For studies in which patients were predominantly infected with genotype 1 or 4 HCV, the pooled SVR rate was 49% (95% CI: 43-55). This was significantly lower than the rate of 59% (95% CI: 54-64) found in studies in which patients were predominantly infected with other genotypes (P = 0.012). Factors associated with successful outcomes included treatment with pegylated interferon and ribavirin, infection with an HCV genotype other than genotype 1 or 4 and the absence of liver damage or human immunodeficiency virus infection at baseline. No significant difference in the SVR rate was observed between weight-adjusted and fixed-dose ribavirin treatment. Overall, 17% (95% CI: 13-23) of adverse events resulted in treatment interruption or dose modification, but only 4% (95% CI: 3-5) resulted in treatment discontinuation.
The outcomes of treatment for HCV infection in low- and middle-income countries were similar to those reported in high-income countries.
评估中低收入国家丙型肝炎病毒 (HCV) 感染治疗的效果，并确定与治疗成功相关的因素。
我们对中低收入国家 HCV 治疗方案的研究进行了系统评价和荟萃分析。主要结局是持续病毒学应答 (SVR)。通过随机效应荟萃回归分析确定与治疗结局相关的因素。
该分析涉及来自 17 个国家的 93 项研究中 12213 名患者的数据。总体 SVR 率为 52%（95%置信区间，CI：48-56）。对于以基因型 1 或 4 HCV 感染为主的患者，汇总 SVR 率为 49%（95%CI：43-55）。这显著低于以其他基因型 HCV 感染为主的患者的 59%（95%CI：54-64）（P = 0.012）。与治疗成功相关的因素包括聚乙二醇干扰素和利巴韦林治疗、感染 HCV 基因型 1 或 4 以外的基因型以及基线时无肝损伤或人类免疫缺陷病毒感染。体重调整和固定剂量利巴韦林治疗的 SVR 率无显著差异。总体而言，17%（95%CI：13-23）的不良事件导致治疗中断或剂量调整，但只有 4%（95%CI：3-5）导致治疗停止。
中低收入国家 HCV 感染治疗的结局与高收入国家报告的结局相似。
