Ramos Paesa C, Arazo Garcés P, Pascual Catalán A, Hermida Lazcano I, Aguirre Errasti J M
Servicio de Medicina Interna, Hospital Miguel Servet, Zaragoza.
Rev Clin Esp. 1998 Apr;198(4):221-5.
To know the efficiency and tolerance of INF therapy for chronic virus C hepatitis (HCV) in HIV infected patients compared with non infected patients.
INF-alpha was administered to 39 patients with chronic hepatitis C virus infection criteria. In 17 cases (43.5%) there was coinfection with HIV. Histologic data were available from 30 patients (75%) and also of viral load during therapy (Amplicor HCV, Roche Diagnostics) from 8 patients. We determined the response at the end of the first two months of therapy (ER), at the end of therapy (FR) and after discontinuation (DR) when the transaminase level was normalized and viral RNA was not detected in cases when it was measured. The response rates to INF were compared between HIV-positive and HIV-negative patients and the secondary effects observed evaluated, as well as tolerance and severity, with a particular emphasis on the CD4 lymphocyte level among HIV-positive patients.
An ER was obtained in nine HIV-positive patients (52.9%) and thirteen HIV-negative patients (59%); an FR in eight HIV-positive patients (47%) and eleven HIV-negative patients (50%), and DR in two HIV-positive patients (13.3%) and four HIV-negative patients (28%); although a lower rate of DR was observed among HIV-positive patients, these differences were not significant. The disappearance of HCV ARN at the end of therapy was similar for both groups of patients in whom it was measured: five HIV-positive patients (62.5%) and twelve HIV-negative patients (63.1%). We must consider that HIV-positive patients had a higher number of poor response predictors to INF. Secondary reactions were observed in a higher number of HIV-negative patients (81.8% versus 40.9%) and the level of CD4 lymphocytes was markedly reduced during and after therapy in three patients.
INF therapy in chronic hepatitis C virus infection in HIV-positive patients initially has a similar efficiency to that observed in HIV-negative patients, although perhaps the maintained response rate is lower. A higher number of secondary reactions among HIV-positive patients was not observed, although possible reductions in CD4 levels must be considered among these patients. The use of INF in these patients --if properly selected--is therefore not contraindicated.
了解与未感染人类免疫缺陷病毒（HIV）的患者相比，HIV感染患者接受干扰素（INF）治疗慢性丙型肝炎病毒（HCV）的疗效和耐受性。
对39例符合慢性丙型肝炎病毒感染标准的患者给予α干扰素治疗。其中17例（43.5%）合并HIV感染。30例患者（75%）有组织学数据，8例患者有治疗期间的病毒载量数据（Amplicor HCV，罗氏诊断公司）。我们测定了治疗前两个月末（早期反应，ER）、治疗结束时（最终反应，FR）和停药后（停药反应，DR）的反应，当转氨酶水平正常且检测到病毒RNA未被检测到时。比较了HIV阳性和HIV阴性患者对干扰素的反应率，并评估了观察到的副作用、耐受性和严重程度，特别关注HIV阳性患者的CD4淋巴细胞水平。
9例HIV阳性患者（52.9%）和13例HIV阴性患者（59%）获得早期反应；8例HIV阳性患者（47%）和11例HIV阴性患者（50%）获得最终反应，2例HIV阳性患者（13.3%）和4例HIV阴性患者（28%）获得停药反应；尽管HIV阳性患者的停药反应率较低，但这些差异无统计学意义。两组接受检测的患者在治疗结束时HCV RNA的消失情况相似：5例HIV阳性患者（62.5%）和12例HIV阴性患者（63.1%）。我们必须考虑到，HIV阳性患者对干扰素治疗反应不佳的预测因素更多。HIV阴性患者出现副作用的人数更多（81.8%对40.9%），3例患者在治疗期间和治疗后CD4淋巴细胞水平明显降低。
HIV阳性患者慢性丙型肝炎病毒感染的干扰素治疗最初疗效与HIV阴性患者相似，尽管维持反应率可能较低。虽然必须考虑这些患者中CD4水平可能降低，但未观察到HIV阳性患者出现更多的副作用。因此，如果选择合适，在这些患者中使用干扰素并无禁忌。
