Insulin resistance predicts re-treatment failure in an efficacy study of peginterferon-α-2a and ribavirin in HIV/HCV co-infected patients

JOURNAL OF HEPATOLOGY

卷:54

Article

Vachon, Marie-Louise C.¹  Factor, Stephanie H.²  Branch, Andrea D.¹  Fiel, Maria-Isabel³  Rodriguez-Torres, Maribel⁴  Braeu, Norbert^1,2,5  Sterling, Richard K.⁶  Talal, Andrew H.^7,8  Dieterich, Douglas T.¹  Sulkowski, Mark S.⁹ 

[1] Mt Sinai Sch Med, Div Liver Dis, New York, NY 10029 USA

[2] Mt Sinai Sch Med, Div Infect Dis, New York, NY 10029 USA

[3] Mt Sinai Sch Med, Dept Pathol, New York, NY 10029 USA

[4] Fdn Invest Diego, San Juan, PR USA

[5] Vet Affairs Med Ctr, Bronx, NY USA

[6] Virginia Commonwealth Univ Hlth Syst, Div Liver Dis, Richmond, VA USA

[7] Weill Cornell Med Coll, Div Gastroenterol & Hepatol, New York, NY USA

[8] Weill Cornell Med Coll, Ctr Study Hepatitis C, New York, NY USA

[9] Johns Hopkins Univ, Div Infect Dis, Sch Med, Baltimore, MD USA

关键词: Insulin resistance;    Hepatitis C virus;    Chronic;    HIV;    Re-treatment;    Antiviral therapy;    Pegylated interferon alfa-2a;    Ribavirin;   

DOI  :  10.1016/j.jhep.2010.06.025

来源: Elsevier

【 摘 要 】

Background & Aims: Few studies evaluated the efficacy of HCV re-treatment and the predictors of response in HIV/HCV coinfected patients. The role of insulin resistance as a predictor of response in this population is unknown. The aim of this study is to evaluate the safety and efficacy of pegylated interferon-alpha-2a and ribavirin in re-treatment of HIV/HCV co-infected patients, predictors of sustained virological response, including insulin resistance, and the relationship between insulin resistance and liver histology. Methods: This prospective, multi-centered study included HIV/HCV co-infected patients with prior interferon-based treatment failure. Patients received pegylated interferon-alpha-2a and ribavirin for 48 weeks. Serum HCV RNA was measured 24 weeks post treatment to assess sustained virological response. Insulin resistance was defined as HOMA-IR >2. Correlations between baseline insulin resistance and steatosis, and/or cirrhosis were determined. Results: Sustained virological response was achieved in 14/96 (15%) patients. 35% of patients with HOMA-IR <2 (6/17) achieved sustained virological response vs 14% (5/36) of those with HOMA-IR between 2-4, and 7% (3/41) of those with HOMA-IR >4 (p = 0.01). In multivariable analysis, insulin resistance and log(10) HCV RNA were negatively associated with sustained virological response [AOR 0.17; 95% CI 0.05-0.64, p = 0.009, and AOR 0.36; 95% CI 0.14-0.93, p = 0.04, respectively]. Steatosis and cirrhosis correlated with insulin resistance (p = 0.02 and 0.03, respectively) but neither independently predicted sustained virological response. Discontinuations due to severe adverse events occurred in 8% of cases, and 2 patients died of unrelated causes. Conclusions: In HIV/HCV co-infected patients undergoing retreatment, sustained virological response rate is low; those patients without insulin resistance are significantly more likely to achieve sustained virological response. (C) 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

【 授权许可】

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