A Sustained Virologic Response Reduces Risk of All-Cause Mortality in Patients With Hepatitis C
A Sustained Virologic Response Reduces Risk of All-Cause Mortality in Patients With Hepatitis C
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DOI：
10.1016/j.cgh.2011.03.004
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发表时间：
2011-06-01
影响因子：
12.6
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.
背景与目的：尽管抗病毒治疗的最终目标是降低死亡率，但聚乙二醇化干扰素和利巴韦林联合治疗丙型肝炎的有效性通常是以持续病毒学应答(SVR)的替代终点来评价的。关于SVR对全因死亡率的影响，在常规医学实践中，丙型肝炎病毒基因分型或合并严重并发症的人群中，并没有很好的记录。方法：美国退伍军人事务部(VA)2001年1月至2007年6月开始丙型肝炎病毒治疗，2008年6月停止治疗，治疗后丙型肝炎病毒RNA检测结果为SVR或无SVR，所有患者均为丙型肝炎病毒感染者，在接受聚乙二醇化干扰素和利巴韦林治疗前无人免疫缺陷病毒重叠感染或肝癌。2009年有来自退伍军人管理局和非退伍军人管理局的死亡率数据。结果：1、2、3型分别为12、166、2904、1794例，SVR率分别为35%、72%、62%。每个队列都有很高的合并症发生率。在中位数约3.8年的随访期内，1119例1型、220例2型和196例3型患者死亡。在控制了人口统计因素、合并症、实验室特征和治疗特征的特定基因型多变量生存模型中，SVR与每种基因型的死亡风险显著降低相关(基因-1风险比，0.70；P<；.0001；基因-2风险比，0.64；P=.006；基因-3风险比，0.51；P=.0002)。结论：SVR降低了感染1、2或3型丙型肝炎病毒的患者的死亡率，这些患者正在接受常规医疗实践治疗，并有实质性的合并症。
BACKGROUND & AIMS: The effectiveness of hepatitis C virus (HCV) treatment with pegylated interferon and ribavirin usually is evaluated by the surrogate end point of sustained virologic response (SVR), although the ultimate goal of antiviral treatment is to reduce mortality. The impact of SVR on all-cause mortality is not well documented by HCV genotype or in populations in routine medical practice with substantial comorbidities. METHODS: From the US Department of Veterans Affairs (VA), we identified all patients infected with HCV genotypes 1, 2, or 3, without human immunodeficiency virus co-infection or hepatocellular carcinoma before HCV treatment with pegylated interferon and ribavirin, who started HCV treatment from January 2001 to June 2007, stopped treatment by June 2008, and had a posttreatment HCV RNA test result of SVR or no SVR. Mortality data from VA and non-VA sources were available through 2009. RESULTS: HCV genotypes 1, 2, or 3 cohorts consisted of 12,166, 2904, and 1794 patients, respectively, with SVR rates of 35%, 72%, and 62%, respectively. Each cohort had high rates of comorbidities. During a median follow-up period of approximately 3.8 years, 1119 genotype-1, 220 genotype-2, and 196 genotype-3 patients died. In genotype-specific multivariate survival models that controlled for demographic factors, comorbidities, laboratory characteristics, and treatment characteristics, an SVR was associated with substantially reduced mortality risk for each genotype (genotype-1 hazard ratio, 0.70; P < .0001; genotype-2 hazard ratio, 0.64; P = .006; genotype-3 hazard ratio, 0.51; P = .0002). CONCLUSIONS: An SVR reduced mortality among patients infected with HCV of genotypes 1, 2, or 3 who were being treated by routine medical practice and had substantial comorbidities.