替拉瑞韦为基础的三联疗法治疗丙型肝炎合并和不合并 HIV 感染患者的病毒学应答率。
Virological response rates for telaprevir-based hepatitis C triple therapy in patients with and without HIV coinfection.
机构信息
Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
出版信息
HIV Med. 2014 Feb;15(2):108-15. doi: 10.1111/hiv.12086. Epub 2013 Sep 11.
OBJECTIVES
Pegylated-interferon/ribavirin dual therapy for hepatitis C virus (HCV) infection has a lower sustained virological response (SVR) rate in HIV/HCV-coinfected patients than in HCV monoinfected patients, but little is known about the relative effectiveness of teleprevir-based triple therapy in the two groups.
METHODS
Data on 33 coinfected and 116 monoinfected patients were analysed on an intention-to-treat basis. SVR12 was defined as undetectable HCV RNA at week 12 post-end-of-treatment, severe anaemia as haemoglobin ≤ 89 g/L or a drop of ≥ 45 g/L, and advanced fibrosis/cirrhosis as Fib-4 ≥ 3.25. All coinfected patients had well controlled HIV infection.
RESULTS
The groups were similar in age, gender, percentage with Fib-4 ≥ 3.25 and HCV viral load, but differed in previous treatment response, with more coinfected patients being nonresponders or treatment-intolerant (75.8% vs. 50.0% for monoinfected patients; P < 0.01). During treatment, the percentages of patients with undetectable HCV RNA were similar, but, surprisingly, this percentage tended to be higher in coinfected patients. SVR12 rates were 60.6% in coinfected patients vs. 42.2% in monoinfected patients (P = 0.06). In multivariable analysis, SVR12 was associated with HIV infection [odds ratio (OR) 3.55; P < 0.01], African American race (OR 0.37; P = 0.03) and previous treatment response (OR 0.46; P = 0.03). Rates of severe anaemia (45.5 vs. 58.6% in coinfected and monoinfected patients, respectively; P = 0.18) were similar in the two groups, but rash (15.2 vs. 34.5%, respectively; P = 0.03) and rectal symptoms (12.1 vs. 43.1%, respectively; P < 0.01) were less common in coinfected patients.
CONCLUSIONS
Virological responses of coinfected and monoinfected patients did not differ significantly, but tended to be higher in coinfected patients, who had a 60.6% SVR12 rate. Telaprevir-based triple therapy is a promising option for coinfected patients with well-controlled HIV infection.
目的
聚乙二醇干扰素/利巴韦林双重疗法治疗丙型肝炎病毒（HCV）感染的持续病毒学应答（SVR）率在 HIV/HCV 合并感染患者中低于 HCV 单感染患者，但对于两种患者人群中替拉瑞韦为基础的三联疗法的相对有效性知之甚少。
方法
对 33 例合并感染和 116 例单感染患者进行了意向治疗分析。SVR12 定义为治疗结束后第 12 周时 HCV RNA 不可检测，严重贫血为血红蛋白≤89g/L 或下降≥45g/L，晚期纤维化/肝硬化为 Fib-4≥3.25。所有合并感染的患者均有良好控制的 HIV 感染。
结果
两组患者在年龄、性别、Fib-4≥3.25 和 HCV 病毒载量的百分比方面相似，但在既往治疗反应方面存在差异，更多的合并感染患者为无应答或不耐受者（分别为 75.8%和 50.0%；P<0.01）。在治疗期间，不可检测到 HCV RNA 的患者百分比相似，但令人惊讶的是，合并感染患者的这一百分比趋势更高。SVR12 率在合并感染患者中为 60.6%，在单感染患者中为 42.2%（P=0.06）。多变量分析显示，SVR12 与 HIV 感染相关（比值比[OR]3.55；P<0.01）、非裔美国人种族（OR 0.37；P=0.03）和既往治疗反应（OR 0.46；P=0.03）。两组患者严重贫血的发生率（合并感染和单感染患者分别为 45.5%和 58.6%；P=0.18）相似，但皮疹（分别为 15.2%和 34.5%；P=0.03）和直肠症状（分别为 12.1%和 43.1%；P<0.01）在合并感染患者中较少见。
结论
合并感染和单感染患者的病毒学反应无显著差异，但合并感染患者的反应趋势更高，SVR12 率为 60.6%。替拉瑞韦为基础的三联疗法是一种有前景的选择，适用于 HIV 得到良好控制的合并感染患者。
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