Infectious Diseases Service, Department of Preventive Medicine, Hospital Universitário Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
PLoS One. 2013 Jul 9;8(7):e67734. doi: 10.1371/journal.pone.0067734. Print 2013.
The standard treatment for chronic hepatitis C virus (HCV) infection in HIV-infected subjects is the combination of alfapeginterferon (PEG-IFN) plus ribavirin. We designed this study to evaluate the rate of SVR and predictors of SVR in a public health setting in Rio de Janeiro, Brazil.
Retrospective cohort study of HCV/HIV co-infected patients treated with PEG-IFN plus ribavirin from 2004 to 2011 in 3 outpatient units in Rio de Janeiro. Exposure variables included age, sex, CD4+ cell count, HCV genotype, HCV and HIV viral loads, liver histology (METAVIR fibrosis scoring system) and previous treatment. The main outcome measurement was SVR.
100 patients were included in this analysis. Median age was 47 years and 68% were male. 80%, 4%, 14% and 2% were infected with HCV genotypes 1, 2, 3 and 4, respectively. At baseline, 77% had HCV viral load greater than 800,000 IU/ml, 99% had CD4+ greater than 200 cells/mm(3) and 10% had a diagnosis of cirrhosis. The treatment was withdrawn in 9% of the subjects (5% with adverse effects and 4% dropped out). SVR was observed in 27 (27%) of the 100 patients included. 13 (13%) subjects were classified as null-responders, 33(33%) as non-responders, 9 (9%) as breakthrough and 9(9%) as relapsers. In the multivariate model only being infected with genotype 2 or 3 (p<0.01) and having low levels of gamma glutamyl transferase (GGT) at baseline (p = 0.04), were predictive of SVR.
SVR in HCV/HIV co-infected subjects in a public health setting is similar to that observed in clinical trials, albeit very low. A delay in therapy initiation should be considered until new therapies as direct acting antiviral drugs (DAA) become widely available and tested in coinfected subjects.
慢性丙型肝炎病毒（HCV）感染合并 HIV 感染的标准治疗方案是聚乙二醇干扰素（PEG-IFN）联合利巴韦林。我们设计本研究旨在评估在巴西里约热内卢公共卫生环境下的 SVR 率和 SVR 的预测因子。
对 2004 年至 2011 年间在里约热内卢的 3 个门诊单位接受 PEG-IFN 联合利巴韦林治疗的 HCV/HIV 合并感染患者进行回顾性队列研究。暴露变量包括年龄、性别、CD4+细胞计数、HCV 基因型、HCV 和 HIV 病毒载量、肝脏组织学（METAVIR 纤维化评分系统）和既往治疗。主要观察指标为 SVR。
本分析纳入 100 例患者。中位年龄为 47 岁，68%为男性。80%、4%、14%和 2%分别感染 HCV 基因型 1、2、3 和 4。基线时，77%的患者 HCV 病毒载量大于 800,000 IU/ml，99%的患者 CD4+大于 200 个细胞/mm³，10%的患者诊断为肝硬化。9%的患者（5%因不良反应和 4%失访而停药）停止治疗。100 例患者中，27 例（27%）达到 SVR。13 例（13%）患者被归类为无应答者，33 例（33%）为非应答者，9 例（9%）为突破者，9 例（9%）为复发者。多变量模型仅显示感染基因型 2 或 3（p<0.01）和基线时γ谷氨酰转移酶（GGT）水平较低（p=0.04）与 SVR 相关。
在公共卫生环境下，HCV/HIV 合并感染患者的 SVR 与临床试验观察到的结果相似，尽管非常低。在新的直接作用抗病毒药物（DAA）广泛应用并在合并感染患者中进行测试之前，应考虑延迟治疗开始时间。
