Pegylated interferon plus ribavirin is suboptimal in IL28B CC carriers without rapid response
Pegylated interferon plus ribavirin is suboptimal in IL28B CC carriers without rapid response
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DOI：
10.1016/j.jinf.2013.03.010
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发表时间：
2013-07-01
影响因子：
28.2
通讯作者：
Pineda, Juan A.
中科院分区：
文献类型：
--
作者：
Neukam, Karin;Barreiro, Pablo;Pineda, Juan A.
目的：一些专家认为，丙型肝炎病毒（HCV）基因型1感染的患者携带IL 28 B基因型CC应与干扰素（聚乙二醇干扰素）联合利巴韦林（RBV）治疗。本研究的目的是评估这些受试者的持续病毒学反应（SVR）的速度，根据他们是否实现快速病毒学反应（RVR）或not.Methods：前瞻性队列研究进行了传染病单位的三家西班牙医院。220例未经治疗的HCV基因型1感染患者，其中160例HIV/HCV合并感染，开始用聚乙二醇干扰素加RBV.Results双重治疗，29例（18%）HIV/HCV合并感染和14例（23%）HCV单一感染（p = 0.44）个体发生RVR。在总体人群中，32名（39%）具有IL 28 B基因型CC的患者与11名（8%）具有基因型非CC的患者实现了RVR（p < 0.0001）。在IL-28 B基因型CC的HCV单一感染患者中，在12例（92%）达到RVR的患者中观察到SVR，在3例（30%）未达到RVR的患者中观察到SVR（p < 0.0018）。HIV/HCV合并感染者的相应数字分别为19（100%）和14（35%）（p < 0.0001）。结论：未经治疗的携带有利IL 28 B基因型的HCV基因型1感染患者，如果未达到RVR，则不应接受包括Peg-IFN和RBV在内的双重治疗。这些主题显然代表候选人更有效的治疗与直接作用antivirals.Summary：一些专家认为，丙型肝炎病毒（HCV）基因型1感染的患者窝藏有利的IL 28 B基因型CC应与干扰素加利巴韦林治疗。然而，携带有利的IL 28 B基因型的患者不应被认为是相同程度的可能应答者。在220名有或没有HIV合并感染的未经治疗的HCV感染患者中进行的这项前瞻性队列研究显示，在IL 28 B CC携带者中，而在4周后血浆HCV-RNA阴性的那些患者的亚组中，双重疗法的快速病毒学应答（rapid virological response，RVR）具有接近100%的持续病毒学应答率，那些不存在RVR的人显示出低于40%的应答率。因此，携带有利的IL 28 B基因型但未达到RVR的未经治疗的HCV基因型1感染患者应被视为使用直接作用的抗病毒药物（如博赛匹韦或特拉匹韦）进行更有效治疗的候选者。(C)2013年，英国传染病协会。由爱思唯尔有限公司出版。保留所有权利。
Objective: Some experts consider that hepatitis C virus (HCV) genotype 1-infected patients harboring IL28B genotype CC should be treated with interferon (Peg-IFN) plus ribavirin (RBV). This study aimed to assess the rate of sustained virological response (SVR) in these subjects, according to whether they achieve rapid virological response (RVR) or not.Methods: Prospective cohort study conducted at the Infectious Diseases Units of three Spanish hospitals. 220 treatment-naive, HCV genotype 1-infected patients, 160 of them HIV/HCV-coinfected, who initiated dual therapy with peg-IFN plus RBV were analyzed in an on-treatment approach.Results: 29 (18%) HIV/HCV-coinfected and 14 (23%) HCV-monoinfected (p = 0.44) individuals developed RVR. In the overall population, 32 (39%) patients with IL28B genotype CC versus 11 (8%) bearing genotype non-CC achieved RVR (p < 0.0001). In HCV-monoinfected patients with IL28B genotype CC, SVR was observed in 12 (92%) of those who achieved RVR and in 3 (30%) of those who did not (p < 0.0018). The corresponding figures for HIV/HCV-coinfected individuals were 19 (100%) and 14 (35%), respectively (p < 0.0001).Conclusion: Treatment-naive HCV-genotype 1-infected patients bearing favorable IL28B genotype should not be treated with dual therapy including Peg-IFN plus RBV if they do not achieve RVR. These subjects clearly represent candidates for more effective therapy with direct-acting antivirals.Summary: Some experts consider that hepatitis C virus (HCV) genotype 1-infected patients harboring the favorable IL28B genotype CC should be treated with interferon plus ribavirin. However, patients harboring favorable IL28B genotype should not be considered likely responders to the same extent. This prospective cohort study conducted in 220 treatment-naive HCV-infected patients with or without HIV coinfection patients shows that among the IL28B CC carriers, while the subset of those patients who achieve negative plasma HCV-RNA after 4 weeks (rapid virological response, RVR) of dual therapy have a rate of sustained virological response near to 100%, those who do not present RVR show a response rate lower than 40%. Therefore, treatment-naive HCV-genotype 1-infected patients bearing favorable IL28B genotype who do not achieve RVR should be considered candidates for more effective therapy with direct-acting antivirals like boceprevir or telaprevir. (C) 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.