RESUMO
CONTEXT: It has been suggested that coinfected patients HCV/HIV must be treated with pegylated interferon associated to ribavirin (PEG+RBV), because of better taxes of sustained virological response when compared to those treated with conventional interferon associated to ribavirin (IFN+RBV). There are few studies in the literature comparing these two treatments options in this population. OBJECTIVE: To evaluate the sustained virological response to the treatment with IFN+RBV versus PEG+RBV in coinfected patients HCV/HIV genotype 1, in a public health program. METHODS: It is a cohort study, where the data of the coinfected patients treated with IFN+RBV (before 2002) or PEG+RBV (from 2002) during 48 weeks in the Brazilian Health Ministry program were reviewed. Demographic characteristics were evaluated (age, gender and weight), CD4 cell count and histopathology - inflammatory activity (A) and fibrosis grade, by METAVIR classification. The significance level adopted was 5%. RESULTS: Eighty one patients were evaluated, 22 treated with IFN+RBV and 59 treated with PEG+RBV. Both were similar relating to age, gender, weight, CD4 cell count and fibrosis grade. Those treated with IFN+RBV presented a greater proportion of A2+A3 patients than those treated with PEG+RBV (P<0.01). The sustained virological response was 14% versus 23% in those using IFN+RBV or PEG+RBV respectively (P = 0.54). The Odds Ratio was 1.9 (0.5 to 7.3). CONCLUSION: Coinfected patients HCV/HIV genotype 1 treated with PEG+RBV presented 1.9 more chance to obtain sustained virological response than those treated with IFN+RBV, however without statistical significance.
Assuntos
Antivirais/administração & dosagem , Infecções por HIV/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/administração & dosagem , Polietilenoglicóis/administração & dosagem , Ribavirina/administração & dosagem , Adulto , Contagem de Linfócito CD4 , Estudos de Coortes , Quimioterapia Combinada , Feminino , Genótipo , Infecções por HIV/complicações , Hepacivirus/genética , Hepatite C Crônica/complicações , Humanos , Interferon alfa-2 , Masculino , Proteínas Recombinantes , Carga ViralRESUMO
CONTEXTO: Tem sido sugerido que os pacientes coinfectados por vírus da hepatite C e da imunodeficiência humana (VHC/HIV) devam ser tratados com interferon peguilado associado à ribavirina (PEG+RBV) porque as taxas de resposta virológica sustentada seriam maiores do que aquelas obtidas com interferon convencional associado à ribavirina (IFN+RBV). No entanto, há escassez de trabalhos na literatura comparando as duas opções de tratamento nesta população de pacientes, em especial fora do cenário de ensaios clínicos. OBJETIVO: Avaliar a resposta virológica sustentada ao tratamento com IFN+RBV versus PEG+RBV em pacientes coinfectados pelo vírus da hepatite C genótipo 1 e vírus da imunodeficiência humana (VHC-1/HIV), no âmbito do programa do Ministério da Saúde. MÉTODOS: Trata-se de estudo de coorte misto, onde foram revisados prontuários de pacientes coinfectados por VHC-1/HIV tratados com IFN+RBV (antes de 2002) ou PEG+RBV (a partir de 2002) pelo período de 48 semanas, no âmbito da Secretaria da Saúde do Estado do Rio Grande do Sul. Foram avaliadas as características demográficas (idade, gênero e peso), contagem de células CD4 e histopatologia - atividade inflamatória (A) e fibrose - segundo classificação METAVIR. O nível de significância adotado na análise estatística foi de 5 por cento. RESULTADOS: Foram avaliados 81 pacientes coinfectados por VHC-1/HIV, 22 que utilizaram IFN+RBV e 59 que utilizaram PEG+RBV por 48 semanas. Os grupos eram semelhantes no que tange à média de idade, gênero, peso, contagem de células CD4 e grau de fibrose. Os pacientes que utilizaram IFN+RBV apresentaram maior atividade histológica com proporção de A2+A3 que superava aqueles que utilizaram PEG+RBV (P<0,01). A resposta virológica sustentada foi 14 por cento no grupo que utilizou IFN+RBV e 23 por cento naqueles que utilizaram PEG+RBV (P = 0,54), com Odds Ratio de 1,9 (0,5 a 7,3). CONCLUSÃO: Os pacientes coinfectados por HCV-1/HIV tratados com PEG+RBV apresentaram...
CONTEXT: It has been suggested that coinfected patients HCV/HIV must be treated with pegylated interferon associated to ribavirin (PEG+RBV), because of better taxes of sustained virological response when compared to those treated with conventional interferon associated to ribavirin (IFN+RBV). There are few studies in the literature comparing these two treatments options in this population. OBJECTIVE: To evaluate the sustained virological response to the treatment with IFN+RBV versus PEG+RBV in coinfected patients HCV/HIV genotype 1, in a public health program. METHODS: It is a cohort study, where the data of the coinfected patients treated with IFN+RBV (before 2002) or PEG+RBV (from 2002) during 48 weeks in the Brazilian Health Ministry program were reviewed. Demographic characteristics were evaluated (age, gender and weight), CD4 cell count and histopathology - inflammatory activity (A) and fibrosis grade, by METAVIR classification. The significance level adopted was 5 percent. RESULTS: Eighty one patients were evaluated, 22 treated with IFN+RBV and 59 treated with PEG+RBV. Both were similar relating to age, gender, weight, CD4 cell count and fibrosis grade. Those treated with IFN+RBV presented a greater proportion of A2+A3 patients than those treated with PEG+RBV (P<0.01). The sustained virological response was 14 percent versus 23 percent in those using IFN+RBV or PEG+RBV respectively (P = 0.54). The Odds Ratio was 1.9 (0.5 to 7.3). CONCLUSION: Coinfected patients HCV/HIV genotype 1 treated with PEG+RBV presented 1.9 more chance to obtain sustained virological response than those treated with IFN+RBV, however without statistical significance.