Chronic hepatitis C treatment outcomes in low- and middle-income countries: a systematic review and meta-analysis
Chronic hepatitis C treatment outcomes in low- and middle-income countries: a systematic review and meta-analysis
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DOI：
10.2471/blt.11.097147
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发表时间：
2012-07-01
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影响因子：
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通讯作者：
duCros, Philipp
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作者：
Ford, Nathan;Kirby, Catherine;duCros, Philipp
目的为了评估丙型肝炎病毒（HCV）感染的治疗效果在低收入和中等收入国家，并确定成功outcome.Methods的相关因素，我们进行了一项系统的回顾和荟萃分析的丙型肝炎病毒治疗方案在低收入和中等收入国家的研究。主要结果是持续病毒学应答（SVR）。与治疗结果相关的因素通过随机效应荟萃回归分析确定。结果-分析涉及来自17个国家的93项研究中的12213例患者的数据。总体SVR率为52%（95%置信区间，CI：48-56）。对于患者主要感染基因型1或4 HCV的研究，合并SVR率为49%（95% CI：43-55）。这显著低于患者主要感染其他基因型的研究中发现的59%（95% CI：54-64）的发生率（P = 0.012）。与成功结局相关的因素包括聚乙二醇干扰素和利巴韦林治疗、HCV基因型1或4型以外的感染以及基线时无肝损伤或人类免疫缺陷病毒感染。体重调整和固定剂量利巴韦林治疗之间的SVR率无显著差异。总体而言，17%（95%CI：13-23）的不良事件导致治疗中断或剂量调整，但只有4%（95%CI：3-5）导致治疗中止。
Objective To assess the effectiveness of treatment for hepatitis C virus (HCV) infection in low- and middle-income countries and identify factors associated with successful outcomes.Methods We performed a systematic review and meta-analysis of studies of HCV treatment programmes in low- and middle-income countries. The primary outcome was a sustained virological response (SVR). Factors associated with treatment outcomes were identified by random-effects meta-regression analysis.Findings-The analysis involved data on 12213 patients included in 93 studies from 17 countries.The overall SVR rate was 52% (95% confidence interval, Cl: 48-56). For studies in which patients were predominantly infected with genotype 1 or 4 HCV, the pooled SVR rate was 49% (95% Cl: 43-55). This was significantly lower than the rate of 59% (95% Cl: 54-64) found in studies in which patients were predominantly infected with other genotypes (P = 0.012). Factors associated with successful outcomes included treatment with pegylated interferon and ribavirin, infection with an HCV genotype other than genotype 1 or 4 and the absence of liver damage or human immunodeficiency virus infection at baseline. No significant difference in the SVR rate was observed between weight-adjusted and fixed-dose ribavirin treatment. Overall, 17% (95% Cl: 13-23) of adverse events resulted in treatment interruption or dose modification, but only 4% (95% Cl: 3-5) resulted in treatment discontinuation.Conclusion The outcomes of treatment for HCV infection in low- and middle-income countries were similar to those reported in high-income countries.