Gupta Varun, Kumar Ashish, Sharma Praveen, Tyagi Pankaj, Bansal Naresh, Singla Vikas, Arora Anil
Department of Gastroenterology & Hepatology, Ganga Ram Institute of Postgraduate Medical Education & Research (GRIPMER), Sir Ganga Ram Hospital, New Delhi, India.
J Clin Exp Hepatol. 2014 Dec;4(4):287-92. doi: 10.1016/j.jceh.2014.08.004. Epub 2014 Sep 16.
In India, both genotype 3 and 1 are predominant genotypes in patients with chronic hepatitis C (CHC). However, there is scanty data on sustained viral response (SVR) rate with conventionally recommended dual therapy with PEG-IFN and ribavirin.
In this retrospective study, consecutive patients of CHC of genotypes 1 and 3, attending the single unit of Gastroenterology of our hospital, who received PEG-IFN and ribavirin therapy, were included. Patients who had co-infection with HIV or HBV were excluded.
A total of 114 patients were included in the study median age 44 (15-72) years, 79% males. Most common presentation was with chronic hepatitis, while 10 (9%) patients had compensated cirrhosis. Nine (8%) patients had associated diabetes, 16 (14%) patients gave history of significant alcohol abuse. The median baseline HCV RNA level was 3.0 × 10(5) (1.7 × 10(3)-1.8 × 10(7)) IU/mL. The most common genotype was 3 (75%) followed by genotype 1 (25%). 70% patients received PegIFN-α2a (median dose 180 MIU/wk) and 30% patients received PegIFN-α2b (median dose 80 MIU/wk). The median ribavirin dose was 800 (range 800-1200) mg. SVR in genotype 1 was 64% (18/28) while SVR in genotype 3 was 73% (63/86). The factors predicting SVR on univariate analysis were a lower baseline HCV RNA level (less than 3.0 × 10(5)), higher hemoglobin level > 11.8 g/dl, and achievement of rapid virological response (RVR), early virological response (EVR) and end of treatment response (ETR). In multivariate analysis the only baseline factor found independently correlating with SVR was low HCV RNA level (<3.0 × 10(5) IU/mL) (P = 0.003).
In north India, HCV genotype 3 has a SVR rate of 73%, which is comparable to genotype 1 with SVR rate of 64% when treated with PEG-IFN and ribavirin therapy. A baseline HCV RNA level lower than 3.0 × 10(5) best predicts SVR in addition to achievement of RVR, EVR or ETR.
在印度，基因型3和1是慢性丙型肝炎（CHC）患者中的主要基因型。然而，关于聚乙二醇干扰素（PEG - IFN）和利巴韦林常规推荐的联合治疗的持续病毒学应答（SVR）率的数据却很少。
在这项回顾性研究中，纳入了我院胃肠病科单一病房接受PEG - IFN和利巴韦林治疗的1型和3型CHC连续患者。排除合并感染HIV或HBV的患者。
共有114例患者纳入研究，中位年龄44（15 - 72）岁，79%为男性。最常见的表现为慢性肝炎，10例（9%）患者有代偿性肝硬化。9例（8%）患者合并糖尿病，16例（14%）患者有大量酗酒史。基线丙型肝炎病毒RNA（HCV RNA）水平中位数为3.0×10⁵（1.7×10³ - 1.8×10⁷）IU/mL。最常见的基因型是3型（75%），其次是1型（25%）。70%的患者接受聚乙二醇干扰素α - 2a（中位剂量180 MIU/周），30%的患者接受聚乙二醇干扰素α - 2b（中位剂量80 MIU/周）。利巴韦林的中位剂量为800（范围800 - 1200）mg。1型基因型的SVR为64%（18/28），而3型基因型的SVR为73%（63/86）。单因素分析中预测SVR的因素包括较低的基线HCV RNA水平（低于3.0×10⁵）、较高的血红蛋白水平>11.8 g/dl，以及实现快速病毒学应答（RVR）、早期病毒学应答（EVR）和治疗结束时应答（ETR）。多因素分析中唯一与SVR独立相关的基线因素是低HCV RNA水平（<3.0×10⁵ IU/mL）（P = 0.003）。
在印度北部，HCV基因型3的SVR率为73%，与接受PEG - IFN和利巴韦林治疗时SVR率为64%的基因型1相当。除了实现RVR、EVR或ETR外，基线HCV RNA水平低于3.0×10⁵最能预测SVR。
