Predictors of response of US veterans to treatment for the hepatitis C virus
Predictors of response of US veterans to treatment for the hepatitis C virus
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DOI：
10.1002/hep.21662
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发表时间：
2007-07-01
期刊：
影响因子：
13.5
通讯作者：
Mole, Larry A.
中科院分区：
文献类型：
--
作者：
Backus, Lisa I.;Boothroyd, Derek B.;Mole, Larry A.
目前推荐的丙型肝炎病毒（HCV）感染治疗方法是聚乙二醇干扰素α（PEG - INF）和利巴韦林，但可能难以耐受。更多有关预测持续病毒学应答（SVR）的信息可能有助于做出更明智的治疗决策。这项回顾性观察队列研究确定了在121家退伍军人事务部机构的常规医疗实践中，对PEG - INF和利巴韦林产生SVR的预测因素。在5944名感染了HCV基因1型、2型或3型且接受了PEG - INF和利巴韦林治疗的患者中，SVR率分别为20%、52%和43%，停药率分别为68%（48周前）、34%（24周）和41%（24周）。在多变量分析中，基因1型患者获得SVR可能性降低的显著预测因素包括：非裔美国人、临床肝病、糖尿病、低胆固醇、低血红蛋白、低血小板计数以及在治疗量小的机构接受治疗。基因1型患者获得SVR可能性增加的预测因素包括：低水平HCV病毒血症、谷丙转氨酶（ALT）比值升高以及接受PEG - INF 2A（而非2B）。对于基因2型患者，体重指数增加、既往使用过干扰素以及低血小板计数是负面预测因素；只有低水平HCV病毒血症是正面预测因素。对于基因3型患者，只有接受PEG - INF 2A影响获得SVR的可能性，且其影响是正面的。结论：在常规医疗护理期间开始接受HCV治疗的患者中，包括所接受的PEG - INF类型在内的多种因素影响基因1型患者的SVR率。这些因素中很少影响基因2型患者的比率，对基因3型患者的影响因素则更少。
The currently recommended treatment for hepatitis C virus (HCV) infection is pegylated interferon alfa (PEG-INF) and ribavirin, which can be difficult to tolerate. More information about predicting sustained virologic response (SVR) may allow more informed treatment decisions to be made. This retrospective observational cohort study identified predictors of SVR to PEG-INF and ribavirin in routine medical practice at 121 Department of Veterans Affairs facilities. Among 5,944 patients infected with HCV genotypes 1, 2, or 3 who had been treated with PEG-INF and ribavirin, SVR rates were 20%, 52%, and 43%, respectively, and discontinuation rates were 68% (prior to 48 weeks), 34% (24 weeks), and 41% (24 weeks), respectively. In multivariate analysis, significant predictors of decreased likelihood of genotype 1 patients having an SVR were being African American, clinical liver disease, diabetes, low cholesterol, low hemoglobin, low platelet count, and treatment at a low-volume facility. Predictors of increased likelihood of genotype 1 patients having an SVR were low-level HCV viremia, elevated ALT quotient, and receiving PEG-INF 2A (rather than 2B). For genotype 2 patients, increasing body mass index, prior use of interferon, and low platelet count were negative predictors; only low-level HCV viremia was a positive predictor. For genotype 3 patients, only receiving PEG-INF 2A affected the likelihood of an SVR; its effect was positive. Conclusion: Among patients for whom HCV treatment is initiated during routine medical care, multiple factors including form of PEG-INF received affect the SVR rate for genotype 1 patients. Few of these factors affect the rate for genotype 2 patients, and even fewer do so for genotype 3 patients.