使用直接作用抗病毒药物治疗慢性基因3型丙型肝炎病毒感染：印度的经验。

Treatment of chronic genotype-3 hepatitis C virus infection using direct-acting antiviral agents: An Indian experience.

作者信息

Goel Amit, Bhargava Rajat, Rai Praveer, Aggarwal Rakesh

机构信息

Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.

出版信息

Indian J Gastroenterol. 2017 May;36(3):227-234. doi: 10.1007/s12664-017-0763-3. Epub 2017 Jun 28.

DOI:10.1007/s12664-017-0763-3

PMID:28656492

Abstract

BACKGROUND

Direct-acting antiviral drugs (DAAs) are favored for the treatment of hepatitis C virus (HCV) infection. However, the experience with the DAAs currently available in India in the treatment of genotype-3 HCV is limited. We therefore reviewed our experience with these drugs in treating patients with chronic genotype-3 HCV infection, including those with cirrhosis.

METHODS

We prospectively followed adult patients with genotype-3 HCV infection who had received treatment regimens containing sofosbuvir with/without daclatasvir. Patients were categorized as chronic hepatitis C (CHC), compensated cirrhosis (CC), and decompensated cirrhosis (DC). They received either (i) sofosbuvir and ribavirin, with or without pegylated interferon (Peg-IFN) for 12 or 24 weeks, or (ii) sofosbuvir and daclatasvir, with or without ribavirin for 12 or 24 weeks. Response was assessed using HCV RNA testing after 2 or 4 weeks of treatment (rapid virological response [RVR]), at treatment completion (end-of-treatment response [ETR]) or 12 weeks after treatment completion (sustained virological response [SVR12]).

RESULTS

Of the 160 patients (90% treatment-naïve; CHC 49%, CC 32%, and DC 19%), 39 (24%) received Peg-IFN, sofosbuvir and ribavirin, 21 (13%) received sofosbuvir and ribavirin, and 100 (63%) received sofosbuvir and daclatasvir, with or without ribavirin. On intention-to-treat basis, RVR, ETR, and SVR12 in the entire cohort were 146/160 (91.3%), 151/160 (94.4%), and 147/160 (91.9%), respectively. Seven patients died (CC 2, DC 5) during treatment; four (2 CHC, 2 DC) patients discontinued treatment; and two patients with CC relapsed.

CONCLUSIONS

Dual-DAA-based regimens were safe and highly effective in treating genotype-3 HCV infection in CHC and CC patients.

摘要

背景

直接抗病毒药物（DAAs）在丙型肝炎病毒（HCV）感染治疗中备受青睐。然而，目前印度可用的DAAs治疗基因3型HCV的经验有限。因此，我们回顾了使用这些药物治疗慢性基因3型HCV感染患者（包括肝硬化患者）的经验。

方法

我们前瞻性地随访了接受含索磷布韦联合或不联合达拉他韦治疗方案的基因3型HCV感染成年患者。患者分为慢性丙型肝炎（CHC）、代偿期肝硬化（CC）和失代偿期肝硬化（DC）。他们接受了以下治疗：（i）索磷布韦和利巴韦林，联合或不联合聚乙二醇干扰素（Peg-IFN）治疗12或24周，或（ii）索磷布韦和达拉他韦，联合或不联合利巴韦林治疗12或24周。在治疗2或4周后（快速病毒学应答[RVR]）、治疗结束时（治疗结束时应答[ETR]）或治疗结束后12周（持续病毒学应答[SVR12]），通过HCV RNA检测评估疗效。

结果

160例患者（90%为初治患者；CHC占49%，CC占32%，DC占19%）中，39例（24%）接受了Peg-IFN、索磷布韦和利巴韦林治疗，21例（13%）接受了索磷布韦和利巴韦林治疗，100例（63%）接受了索磷布韦和达拉他韦治疗，联合或不联合利巴韦林。在意向性分析中，整个队列的RVR、ETR和SVR12分别为146/160（91.3%）、151/160（94.4%）和147/160（91.9%）。7例患者（CC 2例，DC 5例）在治疗期间死亡；4例（2例CHC，2例DC）患者停止治疗；2例CC患者复发。