在治疗后随访期间，双重慢性丙型和乙型肝炎患者的丙型肝炎病毒持续清除和乙型肝炎表面抗原血清学清除增加。

Sustained hepatitis C virus clearance and increased hepatitis B surface antigen seroclearance in patients with dual chronic hepatitis C and B during posttreatment follow-up.

机构信息

Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital and Kaohsiung Medical University College of Medicine, Kaohsiung, Taiwan.

出版信息

Hepatology. 2013 Jun;57(6):2135-42. doi: 10.1002/hep.26266. Epub 2013 Apr 26.

DOI:10.1002/hep.26266

PMID:23322699

Abstract

UNLABELLED

Patients dually infected with hepatitis C virus (HCV)/hepatitis B virus (HBV) have a higher risk of developing advanced liver disease or hepatocellular carcinoma compared with monoinfected patients. Yet, there is a similar rate of sustained virologic response (SVR) after peginterferon alfa-2a and ribavirin combination therapy in these patients compared with HCV-monoinfected patients and a high hepatitis B surface antigen (HBsAg) seroclearance rate. The durability of hepatitis C and B clearance in coinfected patients was investigated in a 5-year follow-up study. Patients with active HCV genotype 1, both HBV-coinfected (n = 97) and HBV-monoinfected (n = 110), underwent 48-week combination therapy with peginterferon alfa-2a plus ribavirin. In patients with active HCV genotype 2 or 3, both HBV-coinfected (n = 64) and monoinfected (n = 50) patients underwent 24-week combination therapy. A total of 295 (91.9%) patients completed treatment and 24 weeks posttreatment follow-up; 264 (89.5%) patients agreed to receive additional follow-up for up to 5 years after the end of treatment. After a median follow-up of 4.6 ± 1.0 years, six of the 232 patients achieving SVR developed HCV RNA reappearance, including five HCV genotype 1/HBV-coinfected patients and one HCV genotype 2/3-monoinfected patient. Subgenomic analysis of the HCV core gene indicated that five patients developed delayed recurrence of HCV infection. Overall, the cumulative recurrence rate of HCV infection was 2.3% (0.4%/year; 95% confidence interval [CI], 0.9%-5.5%). The cumulative HBsAg seroclearance rate was 30.0% (95% CI, 21.5%-42.0%); with 33.1% (95% CI, 21.8%-50.1%) in the 48-week combination therapy group and 24.3% (95% CI, 13.7%-42.9%) in the 24-week therapy group.

CONCLUSION

Peginterferon alfa-2a and ribavirin therapy provides good HCV SVR durability and a high accumulative HBsAg seroclearance rate in patients who are coinfected with HCV and HBV. (HEPATOLOGY 2013;).

摘要

未标注

与单独感染 HCV 的患者相比，同时感染 HCV 和 HBV 的患者发生晚期肝病或肝细胞癌的风险更高。然而，与 HCV 单独感染患者相比，聚乙二醇干扰素 alfa-2a 和利巴韦林联合治疗后，这些患者的持续病毒学应答（SVR）率相似，并且 HBsAg 血清清除率较高。在一项为期 5 年的随访研究中，研究了合并感染患者中 HCV 和 B 型肝炎清除的持久性。患有活动性 HCV 基因 1 型的患者，包括 HBV 合并感染（n = 97）和 HBV 单独感染（n = 110），接受了 48 周的聚乙二醇干扰素 alfa-2a 加利巴韦林联合治疗。患有活动性 HCV 基因 2 或 3 型的患者，包括 HBV 合并感染（n = 64）和单独感染（n = 50），接受了 24 周的联合治疗。共有 295 名（91.9%）患者完成了治疗和治疗后 24 周的随访；264 名（89.5%）患者同意在治疗结束后最多 5 年接受额外的随访。中位随访 4.6 ± 1.0 年后，232 名 SVR 患者中有 6 名出现 HCV RNA 再出现，包括 5 名 HCV 基因 1/HBV 合并感染患者和 1 名 HCV 基因 2/3 单独感染患者。HCV 核心基因的亚基因组分析表明，5 名患者发生了 HCV 感染的延迟复发。总体而言，HCV 感染的累积复发率为 2.3%（0.4%/年；95%置信区间 [CI]，0.9%-5.5%）。HBsAg 血清清除率累积率为 30.0%（95%CI，21.5%-42.0%）；48 周联合治疗组为 33.1%（95%CI，21.8%-50.1%），24 周治疗组为 24.3%（95%CI，13.7%-42.9%）。