Yeung Man Wah, Young Jim, Moodie Erica, Rollet-Kurhajec Kathleen C, Schwartzman Kevin, Greenaway Christina, Cooper Curtis, Cox Joseph, Gill John, Hull Mark, Walmsley Sharon, Klein Marina B
HIV Clin Trials. 2015 May-Jun;16(3):100-10. doi: 10.1179/501100000024. Epub 2015 May 14.
Clinical benefits of achieving a sustained virologic response (SVR) with hepatitis c virus (HCV) therapy beyond reducing liver-related outcomes have not been documented in HIV-coinfected patients, who have multiple competing health problems. To gauge the potential benefits of curing HCV in coinfected people, we examined changes in health-related quality of life (HRQOL), healthcare and substance use, and overall mortality after treatment for HCV Coinfection.
Prospective multicentre cohort study.
Among patients treated for HCV in the Canadian Coinfection Cohort study, self-reported HRQOL (using the EQ-5D), inpatient and outpatient medical visits, and substance use were assessed before, 6 months and 1 year after completing HCV therapy, comparing SVR-achievers and non-responders. Analysis of covariance and zero-inflated negative binomial regression were used to model the effects of SVR on HRQOL and healthcare use, respectively.
Of 1145 patients chronically infected with HCV, 223 (19%) received treatment while under follow-up in the cohort and had HRQOL data collected - 86 (36%) achieved SVR, 68 (29%) did not, 30 (13%) had ongoing treatment, and 39 (17%) had unknown responses. Compared to non-responders, those achieving a SVR had higher HRQOL scores over time (11-unit increase 1 year posttreatment, 95% CI: 2, 21 measured 1 year posttreatment) and a lower rate of health service utilization (adjusted incidence rate ratio: 0.5, 95% CI: 0.3, 0.9). Short-term mortality was low but appeared lower in SVR-achievers (incidence rates: 0.10 vs 0.12 deaths per 100 person-years). However, after successful treatment, a substantial number of patients increased alcohol consumption and continued to inject drugs.
Successful HCV treatment results in a range of health benefits for HIV/HCV-coinfected patients. Ongoing substance use, however, may mitigate the short- and long-term benefits associated with curing HCV.
丙型肝炎病毒（HCV）治疗实现持续病毒学应答（SVR），除了能降低肝脏相关结局外，对合并感染HIV且存在多种健康问题的患者的临床益处尚无文献记载。为评估治愈HCV对合并感染患者的潜在益处，我们研究了HCV合并感染治疗后健康相关生活质量（HRQOL）、医疗保健及药物使用情况的变化，以及总体死亡率。
前瞻性多中心队列研究。
在加拿大合并感染队列研究中接受HCV治疗的患者中，在完成HCV治疗前、治疗后6个月和1年，评估自我报告的HRQOL（使用EQ-5D量表）、住院和门诊就诊情况以及药物使用情况，比较实现SVR者和未应答者。分别使用协方差分析和零膨胀负二项回归对SVR对HRQOL和医疗保健使用的影响进行建模。
在1145例慢性HCV感染患者中，223例（19%）在队列随访期间接受了治疗并收集了HRQOL数据——86例（36%）实现了SVR，68例（29%）未实现，30例（13%）正在接受治疗，39例（17%）应答情况未知。与未应答者相比，实现SVR者随时间推移HRQOL得分更高（治疗后1年增加了11分，95%可信区间：2，21；治疗后1年测量），医疗服务利用率更低（调整后的发病率比：0.5，95%可信区间：0.3，0.9）。短期死亡率较低，但在实现SVR者中似乎更低（发病率：每100人年0.10例死亡对0.12例死亡）。然而，成功治疗后，相当数量的患者增加了酒精消费并继续注射毒品。
成功的HCV治疗为HIV/HCV合并感染患者带来一系列健康益处。然而，持续的药物使用可能会减轻与治愈HCV相关的短期和长期益处。
