Treatment with direct-acting antiviral agents of hepatitis C virus infection in injecting drug users: A prospective study
Treatment with direct-acting antiviral agents of hepatitis C virus infection in injecting drug users: A prospective study
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DOI：
10.1111/jvh.12711
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发表时间：
2017-10-01
影响因子：
2.5
通讯作者：
D'Avolio, A.
中科院分区：
文献类型：
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作者：
Boglione, L.;Pinna, S. Mornese;D'Avolio, A.
在这项前瞻性研究中，我们评估了2015年4月至2016年7月在我们中心招募的PWID队列中针对丙型肝炎病毒（HCV）的新型疗法的有效性和耐受性。在这项分析中，共纳入174例患者：11例（6.3%）接受聚乙二醇干扰素（PEG-IFN）和利巴韦林（RBV）治疗方案，163例（93.7%）接受无IFN治疗。70例患者（40.2%）使用RBV; 59例（33.9%）患者接受美沙酮或丁丙诺啡阿片替代治疗（OST）。总体而言，在162名受试者（93.1%）中观察到持续病毒学应答（SVR），3名受试者（1.7%）出现突破（BT），1名受试者（0.6%）复发，8名受试者（4.6%）脱落。7例患者因临床状况中断治疗：6例（3.4%）肝失代偿，1例死于肝细胞癌（HCC）。在多变量分析中，治疗失败的预测因素如下：白蛋白水平低于3g/dL（OR=7.190; 95%IC =1.236-41.837; P10（OR=5.886; 95%IC =1.411-35.994; P20（OR=1.286; 95%IC =0.556-9.455; P= 0.016）。总之，在PWID中，DAA治疗有效且耐受性良好; MELD>10且白蛋白水平低的血小板减少受试者显示发生严重不良事件和治疗失败的风险较高。
In this prospective study, we evaluated the effectiveness and tolerability of novel therapies against hepatitis C virus (HCV) in a cohort of PWID enrolled at our centre from April 2015 to July 2016. In this analysis, a total of 174 patients were included: eleven (6.3%) were treated with pegylated interferon (PEG-IFN) and ribavirin (RBV) containing regimens, 163 (93.7%) with IFN-free treatments. RBV has been used in 70 patients (40.2%); 59 (33.9%) patients were in opioid substitution therapy (OST) with methadone or buprenorphine. Overall, sustained virological response (SVR) has been observed in 162 subject (93.1%), breakthrough (BT) in three (1.7%), relapse in one (0.6%) and dropout in eight (4.6%). Treatment was interrupted for clinical conditions in seven patients: six (3.4%) had hepatic decompensation and one died for hepatocellular carcinoma (HCC). In multivariate analysis, predictive factors of treatment failure were as follows: albumin level below 3g/dL (OR=7.190; 95% IC=1.236-41.837; P10 (OR=5.886; 95% IC=1.411-35.994; P20 (OR=1.286; 95% IC=0.556-9.455; P=.016). In conclusion, treatment with DAAs was effective and well tolerated in PWID; cirrhotic subjects with MELD>10 and albumin low level showed a higher risk of developing serious adverse events and treatment failure.