140 AIDS, ðóññêîå èçäàíèå, 2009, òîì 2, N¹ 2 L. Martin-Carbonero et al.Наконец, как показало наше <strong>и</strong>сследован<strong>и</strong>е, стойк<strong>и</strong>йответ на терап<strong>и</strong>ю у больных с HCV генот<strong>и</strong>па 4 определялсяранн<strong>и</strong>м <strong>и</strong>счезновен<strong>и</strong>ем в<strong>и</strong>рем<strong>и</strong><strong>и</strong> <strong>и</strong> не зав<strong>и</strong>селот <strong>и</strong>сходной концентрац<strong>и</strong><strong>и</strong> РНК HCV. Однако нужно состорожностью относ<strong>и</strong>ться к эт<strong>и</strong>м данным, посколькуон<strong>и</strong> был<strong>и</strong> получены на сравн<strong>и</strong>тельно небольшом ч<strong>и</strong>слепац<strong>и</strong>ентов. Как <strong>и</strong> для больных с HCV генот<strong>и</strong>па 1, пр<strong>и</strong>генот<strong>и</strong>пе 4 прогност<strong>и</strong>ческая ценность отр<strong>и</strong>цательногорезультата (стойк<strong>и</strong>й ответ на терап<strong>и</strong>ю) для раннего<strong>и</strong>счезновен<strong>и</strong>я РНК HCV была относ<strong>и</strong>тельно н<strong>и</strong>зка. Этоозначает, что пр<strong>и</strong>бл<strong>и</strong>з<strong>и</strong>тельно у 1 / 3больных с HCV генот<strong>и</strong>па4 разв<strong>и</strong>лся стойк<strong>и</strong>й ответ на терап<strong>и</strong>ю, несмотряна то что спустя 4 нед. после начала лечен<strong>и</strong>я у н<strong>и</strong>хне <strong>и</strong>счезла в<strong>и</strong>рем<strong>и</strong>я. Это еще более выражено у больныхс HCV генот<strong>и</strong>па 3, у которых прогност<strong>и</strong>ческая ценностьотр<strong>и</strong>цательного результата (стойк<strong>и</strong>й ответ на терап<strong>и</strong>ю)для раннего <strong>и</strong>счезновен<strong>и</strong>я РНК HCV состав<strong>и</strong>ла43 %. Иным<strong>и</strong> словам<strong>и</strong>, более чем у 50 % эт<strong>и</strong>х больных<strong>и</strong>злечен<strong>и</strong>е наступ<strong>и</strong>ло, несмотря на отсутств<strong>и</strong>е раннейэл<strong>и</strong>м<strong>и</strong>нац<strong>и</strong><strong>и</strong> в<strong>и</strong>руса через 4 нед после начала терап<strong>и</strong><strong>и</strong>.Это <strong>и</strong>сследован<strong>и</strong>е показало, что так же, как у пац<strong>и</strong>ентовбез <strong>ВИЧ</strong>-<strong><strong>и</strong>нфекц<strong>и</strong><strong>и</strong></strong>, у больных гепат<strong>и</strong>том C на фоне<strong>ВИЧ</strong>-<strong><strong>и</strong>нфекц<strong>и</strong><strong>и</strong></strong> решен<strong>и</strong>е о прекращен<strong>и</strong><strong>и</strong> лечен<strong>и</strong>я должноосновываться на результатах, полученных после12 нед. терап<strong>и</strong><strong>и</strong>, <strong>и</strong> не должно смещаться на более ранн<strong>и</strong>есрок<strong>и</strong>. 1,27,37ÁëàãîäàðíîñòèН<strong>и</strong>же переч<strong>и</strong>слены члены <strong>и</strong>сследовательской группыPRESCO (в алфав<strong>и</strong>тном порядке):Aguirrebengoa K, Б<strong>и</strong>льбао; Alcocer F, Валенс<strong>и</strong>я;Alvarez H, Ферроль; Arazo P, Сарагоса; Arrobas I, Бадахос;Asensi V, Овьедо; Barbera JR, Алькасар-де-Сан-Хуан;Barreiro P, Мадр<strong>и</strong>д; Berdun MA, Уэска; Bonet L, Пальмаде-Мальорка;Cadafalch J, Барселона; Cervantes M, Сабадель;Cordero M, Саламанка; Echeverria S, Сантандер;Farina C, Сантандер; Fernandez-Pelaez JM, Мансанарес;Galindo MJ, Валенс<strong>и</strong>я; Garcia-Samaniego J, Мадр<strong>и</strong>д;Gonzalez M, Малага; Guardiola JM, Барселона;Hernandez-Bur<strong>ru</strong>ezo JJ, Хаэн; Jimenez-Nacher I,Мадр<strong>и</strong>д; Lopez Serrano P, Мадр<strong>и</strong>д; Losada E, Сантьяго;Marino A, Ферроль; Martin-Carbonero L, Мадр<strong>и</strong>д;Miralles C, В<strong>и</strong>го; Nunez M, Мадр<strong>и</strong>д; Ocampo A, В<strong>и</strong>го;Portu J, В<strong>и</strong>тор<strong>и</strong>я; Prieto A, Сантьяго; Ramos B, Мадр<strong>и</strong>д;Rodriguez de Castro E, Менорка; Romero M, Мадр<strong>и</strong>д;Samperiz A, Тудела; Sanchez F, Касерес; San Joaquin I,Сарагоса; Santos I, Мадр<strong>и</strong>д; Sepulveda MA, Толедо;Sola J, Памплона; Soriano V, Мадр<strong>и</strong>д.Друг<strong>и</strong>е участн<strong>и</strong>к<strong>и</strong> <strong>и</strong>спанского <strong>и</strong>сследован<strong>и</strong>я эффект<strong>и</strong>вност<strong>и</strong>пэг<strong>и</strong>нтерферона <strong>и</strong> р<strong>и</strong>бав<strong>и</strong>р<strong>и</strong>на у больных с гепат<strong>и</strong>томC <strong>и</strong> <strong>ВИЧ</strong>-<strong>и</strong>нфекц<strong>и</strong>ей (PRESCO) переч<strong>и</strong>слены вразд. «Благодарност<strong>и</strong>».Ф<strong>и</strong>нансовая поддержка. Это <strong>и</strong>сследован<strong>и</strong>е получалоф<strong>и</strong>нансовую поддержку от Исследовательского <strong>и</strong> образовательногофонда борьбы со СПИДом, Фонда LainEntralgo, Испанской сет<strong>и</strong> <strong>и</strong>сследован<strong>и</strong>й в област<strong>и</strong> СПИ-Да (грант RIS, ISCIII-RETIC RD06) <strong>и</strong> Европейской сет<strong>и</strong>по контролю за устойч<strong>и</strong>востью к прот<strong>и</strong>вов<strong>и</strong>русным препаратам(грант LSHM-CT-2004–503359).Авторы заявляют об отсутств<strong>и</strong><strong>и</strong> конфл<strong>и</strong>кта <strong>и</strong>нтересов.Ëèòåðàòóðà1. Davis G. Tailoring antiviral therapy in hepatitis C. Hepatology 2006;43:909–911.2. National Institutes of Health. Consensus Development ConferenceStatement: Management of hepatitis C. Hepatology 2002; 36:3–20.3. Hadzyannis S, Sette H, Morgan T, et al. Peginterferon alpha-2a andribavirin combination therapy in chronic hepatitis C: a randomizedstudy of treatment duration and ribavirin dose. Ann Intern Med2004; 140:346–355.4. Ferenci P, Fried M, Shiffman M, et al. Predicting sustained virologicalresponses in chronic hepatitis C patients treated with peginterferonalfa-2a/ribavirin. J Hepatol 2005; 43:4<strong>25</strong>–433.5. Zeuzem S, Buti M, Ferenci P, et al. Efficacy of 24 weeks treatmentwith peginterferon alfa-2b plus ribavirin in patients with chronichepatitis C infected with genotype 1 and low pretreatment viremia. JHepatol 2006; 44:97–103.6. Jensen D, Morgan T, Marcellin P, et al. Early identification of HCVgenotype 1 patients responding to 24 weeks peginterferon alpha-2a(40kD)/ribavirin therapy. Hepatology 2006; 43:954–960.7. Dalgard O, Bjoro K, Hellum K, et al. Treatment with pegylated interferonand ribavirin in HCV infection with genotype 2 or 3 for 14weeks: a pilot study. Hepatology 2004; 40:1260–1265.8. Von Wagner M, Huber M, Berg T, et al. Peginterferon alfa-2b andribavirin for 12 vs 24 weeks in HCV genotype 2 or 3 chronic hepatitisC. Gastroenterology 2005; 129:522–527.9. Mangia A, Santoro R, Minerva N, et al. Peginterferon alfa-2b andribavirin for 12 vs 24 weeks in HCV genotype 2 or 3. N Engl J Med2005; 352:2609–2617.10. Rockstroh J, Mocroft A, Soriano V, et al. Influence of hepatitis C vi<strong>ru</strong>sinfection on HIV-1 disease progression and response to highly activeantiretroviral therapy. J Infect Dis 2005; 192:992–1002.11. Perez-Olmeda M, Nunez M, Romero M, et al. Pegylated IFN-alpha2bplus ribavirin as therapy for chronic hepatitis C in HIV-infected patients.AIDS 2003; 2:1023–1028.12. Torriani F, Rodriguez-Torres M, Rockstroh J, et al. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C vi<strong>ru</strong>s infection in HIV-infectedpatients. N Engl J Med 2004; 351:438–450.13. Carrat F, Bani-Sadr F, Pol S, et al. Pegylated interferon alfa-2b vs standardinterferon alfa-2b, plus ribavirin, for chronic hepatitis C in HIVinfectedpatients. JAMA 2004; 292:2839–2848.14. Chung R, Andersen J, Volberding P, et al. Peginterferon Alfa-2a plusribavirin versus interferon alfa-2a plus ribavirin for chronic hepatitisC in HIV-coinfected persons. N Engl J Med 2004; 351:451–459.15. Laguno M, Murillas J, Blanco JL, et al. Peginterferon alfa-2b plus ribavirincompared with interferon alfa-2b plus ribavirin for treatment ofHIV/ HCV co-infected patients. AIDS 2004; 18:F27–F36.16. Moreno A, Barcena R, Garcia-Garzon S, et al. Viral kinetics andearly prediction of nonresponse to peg-IFN-alpha-3b plus ribavirinin HCV genotypes 1/4 according to HIV serostatus. J Viral Hepat2006; 13:466–473.17. Ballesteros A, Fuster D, Planas R, Clotet B, Tural C. Role of viralkinetics under HCV therapy in HIV/HCV-coinfected patients. J AntimicrobChemother 2005; 6:824–827.18. Santin M, Shaw E, Garcia M, et al. Efficacy and safety of pegylatedinterferon alpha-2b plus ribavirin for the treatment of chronic hepatitisC in HIV-infected patients. AIDS Res Hum Retrovi<strong>ru</strong>ses 2006;22:315–320.19. Soriano V, Perez-Olmeda M, Rios P, et al. Hepatitis C vi<strong>ru</strong>s (HCV)relapses after anti-HCV therapy are more frequent in HIV-infectedpatients. AIDS Res Hum Retrovi<strong>ru</strong>ses 2004; 20:351–353.20. Voigt E, Schulz C, Klausen G, et al. Pegylated interferon alpha-2bplus ribavirin for the treatment of chronic hepatitis C in HIV coinfectedpatients. J Infect 2005; 51:245–249.21. Soriano V, Puoti M, Sulkowski M, et al. Care of patients with hepatitisC and HIV co-infection. Updated recommendations from the HIV-HCV International Panel. AIDS 2004; 18:1–12.
Èñ÷åçíîâåíèå ÐÍÊ HCV èç ïëàçìû êðîâè ÷åðåç 4 íåä. òåðàïèè êàê ïðåäèêòîð ÓÂÎ14122. Alberti A, Clumeck N, Collins S, et al. Short Statement of the First EuropeanConsensus Conference on the treatment of chronic hepatitisB and C in HIV co-infected patients. J Hepatol 2005; 42:615–624.23. Cargnel A, Angeli E, Mainini A, et al. Open, randomized, multicentreItalian trial on PEG-IFN plus ribavirin versus PEG-IFN monotherapyfor chronic hepatitis C in HIV-coinfected patients on HAART. AntivirTher 2005; 10:309–317.24. Nunez M, Miralles C, Berdun MA, et al. Role of weight-based ribavirindosing and extended duration of therapy in the treatment ofchronic hepatitis C in HIV-infected patients: the PRESCO Trial. AIDSRes Human Retrovi<strong>ru</strong>ses 2007; 23:972–982.<strong>25</strong>. Soriano V, Miralles C, Berdun MA, et al. Frequency and causes ofpremature treatment discontinuation in HIV/HCV-coinfected patientsreceiving pegylated interferon alpha-2a plus weight-basedribavirin. Antivir Ther, 2007; In press.26. Zeuzem S. Heterogeneous virologic response rates to interferonbasedtherapy in patients with chronic hepatitis C: who respondsless well? Ann Intern Med 2004; 140:370–381.27. Soriano V, Puoti M, Sulkowski M, et al. Care of patients coinfectedwith HIV and hepatitis C vi<strong>ru</strong>s: 2007 updated recommendationsfrom the HCV-HIV International Panel. AIDS 2007; 21:1073–1089.28. Sherman K, Shire N, Rouster S, et al. Viral kinetics in hepatitis C orhepatitis C/HIV-infected patients. Gastroenterology 2005; 128:313–327.29. Martinez-Bauer E, Crespo J, Romero-Gomez M, et al. Developmentand validation of two models for early prediction of response to therapyin genotype 1 chronic hepatitis C. Hepatology 2006; 43:72–80.30. Crespo M, Esteban JI, Ribera E, et al. Utility of week-4 viral responseto tailor treatment duration in hepatitis C vi<strong>ru</strong>s genotype 3/HIV coinfectedpatients. AIDS 2007; 21:477–481.31. Hopkins S, Lambourne J, Farrell G, et al. Role of individualization ofHCV therapy duration in HIV/HCV-coinfected individuals. HIV Med2006; 7:248–<strong>25</strong>4.32. Zeuzem S, Fried M, Reddy K, et al. Improving the clinical relevanceof pretreatment viral load as a predictor of sustained virological responsein patients infected with hepatitis C genotype 1 treated withpeginterferon alfa-2a plus ribavirin. In: 57th Annual Meeting of theAmerican Association for the Study of Liver Diseases. Boston, MA;27–31 October 2006; Abstract 209.33. Berg T, Von Wagner M, Hinrichsen H, et al. Definition of a pretreatmentviral load cut-off for an optimized prediction of treatmentoutcome in patients with genotype 1 infection receiving either 48or 72 weeks of peginterferon alfa-2a plus ribavirin. In: 57th AnnualMeeting of the American Association for the Study of Liver Diseases.Boston, MA; 27–31 October 2006; Abstract 350.34. Soriano V, Barreiro P, Nunez M. Management of chronic hepatitisB and C in HIV-coinfected patients. J Antimicrob Chemother 2006;57:815–818.35. Sanchez-Tapias J, Diago M, Escartin P, et al. Peginterferon-alfa 2aplus ribavirin for 48 versus 72 weeks in patients with detectable hepatitisC vi<strong>ru</strong>s RNA at week 4 of treatment. Gastroenterology 2006;131:451–460.36. Berg T, Von Wagner M, Nasser S, et al. Extended treatment durationfor hepatitis C vi<strong>ru</strong>s type 1: comparing 48 versus 72 weeksof peginterferon-alfa-2a plus ribavirin. Gastroenterology 2006;130:1086–1097.37. Uriel A, Moorehead L, Carriero D, Sulkowski M, Dieterich D. TheHepatitis Resource Network Clinical Trials Group. A multicenter,randomized trial of 48 vs 72 weeks of peg-interferon-2b + ribavirinin HIV/HCV co-infected subjects: longer therapy does not correlatewith improved sustained virological response. In: 13th Conferenceon Retrovi<strong>ru</strong>ses and Opportunistic Infections. Denver, CO; 5–8 Feb<strong>ru</strong>ary2006; Abstract 854.38. Fontana R. Optimizing outcomes in hepatitis C: is treatment beyond48 weeks ever justified? Gastroenterology 2006; 130:1357–1362.
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