Department of Gastroenterology, University of Ankara Medical School, Turkey.
Hepatology Institute, University of Ankara, Turkey.
J Infect Dis. 2018 Mar 28;217(8):1184-1192. doi: 10.1093/infdis/jix656.
Interferon is the only treatment option in chronic delta hepatitis (CDH). A CDH database (333 patients, 161 with interferon treatment history) was analyzed for effects of treatment duration on virologic response and clinical outcomes.
Ninety-nine CDH patients who received at least 6 months of interferon were selected. Maintained virologic response (MVR) was defined as hepatitis D virus RNA negative for 2 years after treatment discontinuation. Cumulative median interferon treatment duration was 24 months (range 6-126 months), with a median of 2 courses (range 1-8). Post-treatment median follow-up was 55 months (24-225 months).
Thirty-five patients achieved MVR. Cumulative probability of MVR increased with treatment duration and reached 50% at 5 years. Patients with MVR were less likely to die from liver disease or develop complications compared to patients without MVR (P = .032, P = .006, respectively). Cirrhosis at baseline and no response to therapy (odds ratio 16.1 and 5.23, respectively) predicted an adverse endpoint. Hepatitis B surface antigen clearance occurred in 37% of patients with MVR.
Viral response to interferon increases with treatment duration and favorably affects the natural course of disease. Interferon treatment duration has to be individualized with careful post-treatment assessment.
干扰素是慢性 delta 肝炎（CDH）的唯一治疗选择。分析了一个 CDH 数据库（333 例患者，161 例有干扰素治疗史），以评估治疗持续时间对病毒学应答和临床结局的影响。
选择了 99 例接受至少 6 个月干扰素治疗的 CDH 患者。维持病毒学应答（MVR）定义为治疗停止后 2 年内乙型肝炎病毒 RNA 阴性。累积中位数干扰素治疗持续时间为 24 个月（范围 6-126 个月），中位数为 2 个疗程（范围 1-8）。治疗后中位随访时间为 55 个月（24-225 个月）。
35 例患者达到 MVR。随着治疗时间的延长，MVR 的累积概率增加，5 年内达到 50%。与未达到 MVR 的患者相比，达到 MVR 的患者因肝病死亡或发生并发症的可能性较小（P=.032，P=.006）。基线时的肝硬化和治疗无应答（比值比分别为 16.1 和 5.23）预测不良结局。37%的 MVR 患者出现乙型肝炎表面抗原清除。
干扰素对病毒的应答随治疗时间的延长而增加，并对疾病的自然病程产生有利影响。干扰素治疗持续时间必须个体化，并在治疗后进行仔细评估。
