丙型肝炎病毒/艾滋病毒阳性患者对丙型肝炎病毒治疗的反应能否预测死亡率？

Is response to anti-hepatitis C virus treatment predictive of mortality in hepatitis C virus/HIV-positive patients?

出版信息

AIDS. 2017 Mar 13;31(5):661-668. doi: 10.1097/QAD.0000000000001378.

Abstract

BACKGROUND

Long-term clinical outcomes after hepatitis C virus (HCV) treatment of HIV/HCV patients are not well described. We aimed to compare the risk of all-cause and liver-related death (LRD) according to HCV treatment response in HIV/HCV patients in the multicohort study Collaboration of Observational HIV Epidemiological Research in Europe.

METHODS

All patients who had started pegylated interferon + ribavirin (baseline) and followed for at least 72 weeks after baseline were included. Patients were categorized into three response groups depending on treatment duration and HCV-RNA measured in the window 24-72 weeks after baseline. Patients who received at least 24 weeks of therapy were defined as responders if their last HCV-RNA measured between 24 and 72 weeks after baseline was negative, and having 'unknown response' if HCV-RNA was unknown. Nonresponders were treated for less than 24 weeks or were HCV-RNA+ between 24 and 72 weeks after baseline. Mortality rates were compared using survival analysis, and Cox regression was used to compare hazard ratios of death between response groups.

RESULTS

A total of 3755 patients were included: 1031 (27.5%) responders, 1639 (43.6%) nonresponders and 1085 (28.9%) with unknown response. Rates [per 1000 person-years of follow-up, 95% confidence interval (CI)] of all-cause death were 17.59 (14.88-20.78), 10.43 (7.62-14.28) and 11.00 (8.54-14.23) for nonresponders, responders and unknown responders, respectively. After adjustment, the relative hazard (nonresponders vs. responders) for all-cause death, LRD and nonliver-related death was 1.53 (95% CI 1.06-2.22), 3.39 (95% CI 1.32-8.75) and 1.22 (95% CI 0.80-1.84), respectively.

CONCLUSION

HIV/HCV patients with a favourable virological response to pegylated interferon + ribavirin had reduced risk of all-cause and LRD, whereas there was no difference in risk of nonliver-related death when comparing responders and nonresponders.

摘要

背景

丙型肝炎病毒（HCV）感染的HIV/HCV患者接受治疗后的长期临床结局尚无充分描述。在欧洲观察性HIV流行病学研究协作组的多队列研究中，我们旨在比较HIV/HCV患者根据HCV治疗反应的全因死亡和肝脏相关死亡（LRD）风险。

方法

纳入所有开始接受聚乙二醇化干扰素+利巴韦林治疗（基线）并在基线后至少随访72周的患者。根据治疗持续时间和基线后24至72周期间测得的HCV-RNA，将患者分为三个反应组。接受至少24周治疗的患者，如果其在基线后24至72周测得的最后一次HCV-RNA为阴性，则定义为反应者；如果HCV-RNA情况未知，则定义为“反应未知”。无反应者接受治疗少于24周或在基线后24至72周期间HCV-RNA呈阳性。使用生存分析比较死亡率，并使用Cox回归比较反应组之间的死亡风险比。

结果

共纳入3755例患者：1031例（27.5%）反应者，1639例（43.6%）无反应者和1085例（28.9%）反应未知者。无反应者、反应者和反应未知者的全因死亡率[每1000人年随访，95%置信区间（CI）]分别为17.59（14.88-20.78）、10.43（7.62-14.28）和11.00（8.54-14.23）。调整后，无反应者与反应者相比，全因死亡、LRD和非肝脏相关死亡的相对风险分别为1.53（95%CI 1.06-2.22）、3.39（95%CI 1.32-8.75）和1.22（95%CI 0.80-1.84）。