Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avenida de Bellavista S/N, 41014 Seville, Spain.
J Antimicrob Chemother. 2013 Apr;68(4):915-21. doi: 10.1093/jac/dks488. Epub 2012 Dec 12.
Accurate prediction of sustained virological response (SVR) to pegylated interferon-α (Peg-IFN) plus ribavirin in HIV/hepatitis C virus (HCV)-coinfected patients could improve the management of these patients. We aimed to develop a model to predict SVR to Peg-IFN/ribavirin in HIV/HCV-coinfected individuals combining HCV genotype and baseline HCV RNA load with interleukin 28B and low-density lipoprotein receptor genetic variations.
Three hundred and twelve treatment-naive HIV/HCV-coinfected patients receiving Peg-IFN/ribavirin were analysed in an on-treatment approach. One hundred and eighty-one of them were included in the development group and 131 in the validation population. The predictive model was obtained from a logistic regression equation including the above-mentioned variables. The areas under the receiver operating characteristic (AUROC) curves (95% CI), sensitivity and specificity, as well as negative and positive predictive values, were calculated.
SVR was achieved by 88 (48.6%) patients from the development group and 68 (51.9%) individuals from the validation group. The AUROC curve values (95% asymptotic CI) were 0.83 (0.77-0.89) for the development group and 0.84 (0.77-0.91) for the validation group. Using two cut-off values, maximum specificity and sensitivity were 89.7% and 96.6%, respectively, with a negative predictive value for SVR of 88.9% and a positive predictive value of 83.6%. Thirteen (7.2%) individuals were misclassified using these cut-off values.
This model represents a reliable and easily applicable tool to individually evaluate the probability of achieving an SVR to Peg-IFN/ribavirin among HIV/HCV-coinfected patients.
准确预测 HIV/丙型肝炎病毒（HCV）合并感染患者对聚乙二醇干扰素-α（Peg-IFN）加利巴韦林的持续病毒学应答（SVR），可以改善这些患者的治疗管理。我们旨在建立一个模型，结合 HCV 基因型和基线 HCV RNA 载量以及白细胞介素 28B 和低密度脂蛋白受体遗传变异，预测 HIV/HCV 合并感染个体对 Peg-IFN/利巴韦林的 SVR。
对 312 例接受 Peg-IFN/利巴韦林治疗的初治 HIV/HCV 合并感染患者进行了治疗中的分析。其中 181 例患者纳入模型建立组，131 例患者纳入验证人群。通过包括上述变量的逻辑回归方程得出预测模型。计算受试者工作特征（ROC）曲线下面积（95%CI）、敏感性和特异性以及阴性和阳性预测值。
模型建立组中 88（48.6%）例患者和验证组中 68（51.9%）例患者达到 SVR。ROC 曲线下面积（95%渐近 CI）值分别为模型建立组 0.83（0.77-0.89）和验证组 0.84（0.77-0.91）。使用两个截断值，最大特异性和敏感性分别为 89.7%和 96.6%，SVR 的阴性预测值为 88.9%，阳性预测值为 83.6%。使用这些截断值有 13 例（7.2%）患者被错误分类。
该模型是一种可靠且易于应用的工具，可以单独评估 HIV/HCV 合并感染患者对 Peg-IFN/利巴韦林达到 SVR 的可能性。
