RESUMO
Objetivo El objetivo de este estudio fue evaluar si la determinación de RNA del virus de la hepatitis C (VHC-RNA) a las 12 semanas tras la finalización del tratamiento podía predecir la respuesta viral sostenida al tratamiento anti-VHC (interferón pegilado alfa-2a y ribavirina) en enfermos coinfectados por el virus de la inmunodeficiencia humana (VIH).Enfermos y métodos Fueron incluidos los pacientes coinfectados por VIH y VHC que completaron un curso completo de tratamiento anti-VHC y que fueron evaluados a las semanas +12 y +24 tras la finalización del tratamiento para determinación del HCV-RNA sérico (RealTime HCV (Abbott, Wiesbaden, Alemania) (límite inferior de detección, 12 U/ml).Resultados Cuarenta de los 66 enfermos tratados (61%) presentaron una respuesta al final del tratamiento. Se les realizó una valoración a las 12 y 24 semanas tras el fin de la terapia. El VHC-RNA sérico fue indetectable en 28 de ellos a la semana +12, y el 100% de ellos permaneció indetectable a la semana +24 (el patrón de referencia de respuesta viral sostenida). El valor predictivo positivo fue 100% (intervalo de confianza al 95% 98,21-100%).Conclusión La evaluación posterior al tratamiento de la hepatitis crónica C en enfermos coinfectados por VIH para detectar la presencia de recaída virológica puede ser realizada a la semana +12, en lugar de a la semana +24, proporcionando así una nueva definición de respuesta virológica sostenida (AU)
Objective The aim of this study was to assess whether measurement of hepatitis C virus RNA (HCV-RNA) at 12 weeks post-treatment could predict sustained virological response (SVR) to antiviral therapy for chronic hepatitis C (pegylated interferon alfa-2a and ribavirin) in HIV-co-infected patients. Patients and methods HIV-HCV co-infected patients were included if they completed a full course of anti-HCV therapy, achieved an end-of-treatment response and complied with the week +12 and +24 post-treatment follow-up schedule for serum HCV-RNA determination (Real-time HCV (Abbott, Wiesbaden, Germany) (lower limit of detection, 12 IU/ml).Results Forty out of 66 patients (61%) showed an end-of-treatment response. They were assessed in a follow-up visit at +12 and at +24 weeks post-treatment. Serum HCV-RNA was undetectable in 28 of them at +12 weeks, and 100% of these remained undetectable at 24 weeks post-treatment (the gold standard of (SVR). The positive predictive value was 100% (95% confidence interval, 98.21-100%).Conclusion Post-treatment follow-up to identify virological relapse could be shortened to 12 weeks, providing a new definition of sustained virological response (AU)
Assuntos
Humanos , RNA Viral/análise , Hepacivirus/patogenicidade , Hepatite C Crônica/microbiologia , Hepatite C Crônica/complicações , Infecções por HIV/complicações , Interferons/uso terapêutico , Carga Viral , Ribavirina/uso terapêuticoRESUMO
OBJECTIVE: The aim of this study was to assess whether measurement of hepatitis C virus RNA (HCV-RNA) at 12 weeks post-treatment could predict sustained virological response (SVR) to antiviral therapy for chronic hepatitis C (pegylated interferon alfa-2a and ribavirin) in HIV-co-infected patients. PATIENTS AND METHODS: HIV-HCV co-infected patients were included if they completed a full course of anti-HCV therapy, achieved an end-of-treatment response and complied with the week +12 and +24 post-treatment follow-up schedule for serum HCV-RNA determination (Real-time HCV (Abbott, Wiesbaden, Germany) (lower limit of detection, 12 IU/ml). RESULTS: Forty out of 66 patients (61%) showed an end-of-treatment response. They were assessed in a follow-up visit at +12 and at +24 weeks post-treatment. Serum HCV-RNA was undetectable in 28 of them at +12 weeks, and 100% of these remained undetectable at 24 weeks post-treatment (the gold standard of (SVR). The positive predictive value was 100% (95% confidence interval, 98.21-100%). CONCLUSION: Post-treatment follow-up to identify virological relapse could be shortened to 12 weeks, providing a new definition of sustained virological response.
Assuntos
Infecções por HIV/complicações , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/virologia , Carga Viral , Adulto , Feminino , Infecções por HIV/sangue , Hepatite C Crônica/sangue , Hepatite C Crônica/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , RNA Viral/sangue , Fatores de TempoRESUMO
BACKGROUND AND AIMS: Analysis of the influence of the effects of increased intestinal permeability on haemodynamic alterations in human immunodeficiency virus (HIV)-infected patients with decompensated hepatitis C virus (HCV)-related liver disease. METHODS: Forty HIV/HCV co-infected patients and 40 HCV mono-infected patients, 20 of them with compensated cirrhosis and 20 with a previous decompensation, and 20 healthy controls, were studied. Intestinal permeability was determined by serum levels of lipopolysaccharide-binding protein (LBP). Monocyte expression of toll-like receptor 4 (TLR-4), serum levels of interleukin (IL)-6 and soluble receptors of tumour necrosis factor (sTNFRI) were analysed. Cardiac index, systemic vascular resistance (SVR), plasma renin activity (PRA) and aldosterone concentration were also determined in cirrhotic patients. RESULTS: Serum levels of LBP, TLR-4, IL-6 and sTNFRI were significantly higher in HIV-HCV co-infected and HCV mono-infected patients with decompensated cirrhosis compared with those with compensated liver disease. Significantly lower values of SVR and higher values of cardiac index, PRA and aldosterone concentration were observed in patients with decompensated cirrhosis compared with those with compensated liver disease, particularly in those with elevated levels of IL-6. There were no significant differences between HIV/HCV co-infected and HCV mono-infected patients. CONCLUSIONS: Higher intestinal permeability and consequent macrophage activation is observed in patients with cirrhosis; this permeability is even higher in those with portal hypertension. Serum values of IL-6 are associated with the characteristic haemodynamic derangement observed in advanced phases of cirrhosis. HIV/HCV co-infected cirrhotic patients present inflammatory and systemic haemodynamic alterations similar to those observed in HCV mono-infected patients.
