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Discussion on optimal duration of pegylated interferon α combined with ribavirin for chronic hepatitis C in HIV-infected patients



Discussion on optimal duration of pegylated interferon α combined with ribavirin for chronic hepatitis C in HIV-infected patients



Zhonghua Gan Zang Bing Za Zhi 26(4): 282-287



目的: 探讨聚乙二醇干扰素α(Peg-INFα)联合利巴韦林(RBV)治疗人类免疫缺陷病毒(HIV)合并丙型肝炎病毒(HCV)感染者的最佳时机。 方法: 为前瞻性多中心研究,A组:158例,HIV合并HCV感染者;B组:对照组,60例,单一HCV感染者,均接受Peg-INFα联合RBV标准治疗。A组根据CD4(+)T淋巴细胞计数分为3个亚组:A1组,79例,CD4(+)T淋巴细胞>350个/μl,先抗HCV治疗再进行联合抗病毒治疗(cART);A2组,45例,CD4(+)T淋巴细胞200~350个/μl,先给予cART,耐受后开始抗HCV治疗;A3组,34例,CD4(+)T淋巴细胞<200个/μl,先给予cART,待CD4(+) T淋巴细胞> 200个/μl开始抗HCV治疗。比较各组及亚组间抗HCV的疗效。对于服从正态分布、方差齐性资料两组之间采用t检验,计数资料采用χ(2)检验(或Fisher确切概率法),非正态数据采用Mann-Whitney U检验。多组均数比较采用单向方差分析,随后进行SNK检验。多组疗效比较采用多个独立样本非参数检验。 结果: 各组及亚组年龄、基线HCV RNA水平,差异无统计学意义(P值均> 0.05)。两组意向性分析:A组完全早期病毒学应答率(cEVR)率75.3%(119/158),治疗结束时病毒学应答(eTVR)率68.4%(108/158),持续病毒学应答(SVR)率48.7%(77/158);B组cEVR率93.3%(56/60),eTVR率90.0%(54/60),SVR率71.7%(43/60),A组各疗效指标明显低于B组,差异有统计学意义(P值均< 0.05)。经过符合方案分析,A组cEVR率仍低于B组(P < 0.05),但eTVR率及SVR率与B组比较,差异无统计学意义(P值均> 0.05)。A组各亚组间疗效比较,意向性分析:A1亚组cEVR率78.5%(62/79),eTVR率68.4%(54/79),SVR率41.8%(33/79);A2亚组cEVR率75.6%(34/45),eTVR率80.0%(36/45),SVR率64.4%(29/45);A3亚组cEVR率67.6%(23/34),eTVR率52.9%(18/34),SVR率44.1%(15/34)。A2亚组的eTVR率、SVR率分别明显高于A3、A1亚组,差异有统计学意义(P值均< 0.05)。经过符合方案分析,各亚组疗效的差异无统计学意义(P值均> 0.05)。 结论: HIV合并HCV感染使用Peg-INFα-2a联合RBV可获得良好抗HCV疗效,患者CD4(+)T淋巴细胞计数为200个/μl时,是开始抗HCV治疗的最佳时机。.

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Accession: 058427094

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PMID: 29996340


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