Marcellin P, Boyer N, Behamou J P, Erlinger S
Service d'Hépatologie and INSERM U24, Hôpital Beaujon, Clichy, France.
Dig Dis Sci. 1996 Dec;41(12 Suppl):126S-130S. doi: 10.1007/BF02087888.
Interferon-alpha therapy for chronic hepatitis C in special patient populations raises a number of issues. Patients with hemophilia, kidney disease requiring hemodialysis, mixed cryoglobulinemia, HIV infection, and those receiving an allograft share some characteristics that complicate the treatment of hepatitis C virus infections. These patients generally have some degree of immune deficiency, higher levels of hepatitis C virus replication, and are infected with genotypes 1a or 1b. Each of these characteristics is often associated with a poor response to interferon therapy. Clinical research in this area also has been limited. Current data and clinical experience demonstrate that interferon-alpha therapy should be considered in patients with hemophilia who have concurrent hepatitis C viral infection. Other hepatitis C virus-infected patient populations in which interferon-alpha therapy may be beneficial include those undergoing hemodialysis, mixed cryoglobulinemia, or HIV infection. Further, the high incidence of relapse following treatment cessation in these patients warrants prolonged administration of interferon-alpha. Patients undergoing renal or hepatic allograft transplantation who develop hepatitis C virus infections are not as likely to benefit from interferon-alpha therapy. These patients may be at risk for allograft rejection during interferon treatment.
针对特殊患者群体的慢性丙型肝炎进行干扰素-α治疗引发了诸多问题。患有血友病、需要血液透析的肾病患者、混合性冷球蛋白血症患者、HIV感染者以及接受同种异体移植的患者具有一些共同特征，这些特征使丙型肝炎病毒感染的治疗变得复杂。这些患者通常存在一定程度的免疫缺陷、丙型肝炎病毒复制水平较高，并且感染的是1a或1b基因型。这些特征中的每一个往往都与对干扰素治疗的不良反应相关。该领域的临床研究也很有限。目前的数据和临床经验表明，对于同时感染丙型肝炎病毒的血友病患者应考虑使用干扰素-α治疗。其他可能从干扰素-α治疗中获益的丙型肝炎病毒感染患者群体包括接受血液透析的患者、混合性冷球蛋白血症患者或HIV感染者。此外，这些患者停药后复发率较高，因此有必要延长干扰素-α的给药时间。发生丙型肝炎病毒感染的肾或肝同种异体移植患者不太可能从干扰素-α治疗中获益。这些患者在干扰素治疗期间可能有发生同种异体移植排斥反应的风险。
