Rivero-Juarez Antonio, López-Cortés Luis F, Camacho Angela, Torres-Cornejo Almudena, Gordon Ana, Ruiz-Valderas Rosa, Torre-Cisneros Julian, Pineda Juan A, Viciana Pompeyo, Rivero Antonio
Unidad de Enfermedades Infecciosas, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain.
Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.
PLoS One. 2014 Jun 19;9(6):e99468. doi: 10.1371/journal.pone.0099468. eCollection 2014.
Optimizing HCV genotype 1 therapy in terms of response prediction and tailoring treatment is undoubtedly the cornerstone of treating HIV co-infected patients in clinical practice. Accordingly, our aim was to analyze the predictive value of HCV viral decline for sustained virological response (SVR), measured at a time point as early as week 2 of therapy with pegylated interferon alpha-2a plus ribavirin (Peg-IFN/RBV).
Previously untreated HIV/HCV genotype 1 co-infected patients were included in this study. The HCV RNA titer was measured at week 2 after starting treatment with Peg-IFN/RBV. The likelihood of reaching SVR when HCV RNA viral titers declined at week 2 was evaluated relative to predictive baseline factors.
A total of 192 HIV/HCV genotype-1 co-infected patients were enrolled in the study and began therapy. One hundred and sixty-three patients completed a full course of Peg-IFN/RBV treatment for 2 weeks and 59 of these (36.2%) reached SVR. An HCV RNA viral load decline of ≥1.5 log IU/mL at week 2 had the maximum positive predictive value for SVR (83.3%; 95% CI: 68.5%-92.9%) and was identified as the strongest independent predictive factor for reaching SVR across all baseline predictive factors.
HCV viral decline at week 2 had a high predictive value for identifying patients with a high and low likelihood of reaching SVR using dual therapy, regardless of strong predictive baseline factors. This finding may be useful for developing a predictive tool to help tailor HCV genotype 1 therapy in HIV co-infected patients.
在临床实践中，优化丙型肝炎病毒1型（HCV genotype 1）治疗的反应预测并量身定制治疗方案无疑是治疗合并感染HIV患者的基石。因此，我们的目的是分析在聚乙二醇化干扰素α-2a加利巴韦林（Peg-IFN/RBV）治疗的第2周这一早期时间点所测得的HCV病毒载量下降对持续病毒学应答（SVR）的预测价值。
本研究纳入了既往未接受治疗的HIV/HCV基因型1合并感染患者。在开始使用Peg-IFN/RBV治疗后的第2周测量HCV RNA滴度。相对于预测性基线因素，评估第2周时HCV RNA病毒滴度下降时达到SVR的可能性。
共有192例HIV/HCV基因型1合并感染患者纳入本研究并开始治疗。163例患者完成了为期2周的Peg-IFN/RBV全疗程治疗，其中59例（36.2%）达到SVR。第2周时HCV RNA病毒载量下降≥1.5 log IU/mL对SVR具有最大的阳性预测价值（83.3%；95%置信区间：68.5%-92.9%），并且在所有基线预测因素中被确定为达到SVR的最强独立预测因素。
无论基线预测因素如何，第2周时的HCV病毒载量下降对于识别使用联合治疗达到SVR可能性高低的患者具有很高的预测价值。这一发现可能有助于开发一种预测工具，以帮助为合并感染HIV的患者量身定制HCV基因型1治疗方案。
