Johann Wolfgang Goethe University Medical Center, Frankfurt am Main, Germany.
J Viral Hepat. 2012 Nov;19(11):766-74. doi: 10.1111/j.1365-2893.2012.01624.x. Epub 2012 May 14.
It is unclear whether the current threshold for 'high' hepatitis C virus (HCV) RNA level (800,000 IU/mL) is optimal for predicting sustained virological response (SVR). We retrospectively analysed pretreatment HCV RNA levels and SVR rates in 1529 mono-infected and 176 HIV-HCV co-infected patients treated with peginterferon alfa-2a (40 kD) plus ribavirin. We improved the threshold for differentiating low and high viral load by fitting semiparametric generalized additive logistic regression models to the data and constructing receiver operating characteristics curves. Among HCV genotype 1 mono-infected patients, the difference in SVR rates between those with low and high baseline HCV RNA levels was 27% (70%vs 43%) when 400,000 IU/mL was used and 16% (59%vs 43%) when 800,000 IU/mL was used. In HIV-HCV genotype 1 co-infected patients, the difference was 51% (71%vs 20%) when 400,000 IU/mL was used and 43% (61%vs 18%) when 800,000 IU/mL was used. A lower threshold (200,000 IU/mL) was identified for genotype 1 mono-infected patients with 'normal' alanine aminotransferase (ALT) levels. No threshold could be identified in HCV genotype 2 or 3 patients. A threshold HCV RNA level of 400,000 IU/mL is optimal for differentiating high and low probability of SVR in genotype 1-infected individuals with elevated ALT.
目前，对于预测持续病毒学应答（SVR），丙型肝炎病毒（HCV）RNA 水平的“高”阈值（80 万 IU/mL）是否最佳尚不清楚。我们回顾性分析了接受聚乙二醇干扰素 alfa-2a（40kD）联合利巴韦林治疗的 1529 例单纯感染和 176 例 HIV-HCV 合并感染患者的治疗前 HCV RNA 水平和 SVR 率。我们通过拟合半参数广义加性逻辑回归模型对数据进行分析，并构建受试者工作特征曲线，改进了区分低病毒载量和高病毒载量的阈值。在 HCV 基因型 1 单纯感染患者中，当使用 40 万 IU/mL 时，低基线 HCV RNA 水平和高基线 HCV RNA 水平患者的 SVR 率差异为 27%（70% vs 43%），当使用 80 万 IU/mL 时，SVR 率差异为 16%（59% vs 43%）。在 HIV-HCV 基因型 1 合并感染患者中，当使用 40 万 IU/mL 时，SVR 率差异为 51%（71% vs 20%），当使用 80 万 IU/mL 时，SVR 率差异为 43%（61% vs 18%）。对于丙氨酸氨基转移酶（ALT）水平“正常”的基因型 1 单纯感染患者，确定了较低的阈值（20 万 IU/mL）。在 HCV 基因型 2 或 3 患者中无法确定阈值。对于 ALT 升高的基因型 1 感染者，40 万 IU/mL 的 HCV RNA 水平阈值是区分 SVR 高概率和低概率的最佳选择。
