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HIV共感染患者のC型肝炎に対するソフォスブウィールとリバビリン
Mark S Sulkowski1, Susanna Naggie2, Jacob Lalezari3
1Viral Hepatitis Center, Johns Hopkins University, Baltimore, Maryland.
JAMA
|July 20, 2014
まとめ
ソフォスブービルとリバビリンは,HIV共感染患者のC型肝炎ウイルス (HCV) を効果的に治療し,HIV疾患や治療に悪影響を及ぼさず,高い持続的なウイルス反応率を達成しました.
科学分野:
- ヘパトロジーと感染症
- 抗ウイルス療法研究 抗ウイルス療法研究
- HIV/HCV共感染管理について
背景:
- ヒト免疫不全ウイルス (HIV) に共感染した患者におけるC型肝炎ウイルス (HCV) 治療は,薬物相互作用とインターフェロンベースの治療法により困難です.
- 以前のHCV-HIV共感染の治療法は限られていたため,インターフェロン無効の治療法を検討する必要がありました.
研究 の 目的:
- HCVとHIVに共感染した患者におけるソフォスブビルとリバビリンの持続性ウイルス反応 (SVR) によって測定される有効性を評価する.
- 標的集団における,この経口,インターフェロンフリー治療法の安全性と有害事象を評価する.
主な方法:
- HCVゲノタイプ1,2または3と同時にHIV感染している223人の患者が参加したオープンラベルのフェーズ3試験です.
- 患者は,HCV遺伝子型と治療歴に応じて,12週または24週間のソフォスブウィールと体重ベースのリバビリンを投与されました.
- 適格性には,HIVに対する安定した抗レトロウイルス治療 (ART) または,特定のCD4+T細胞数を持つ未治療HIVが必要である.
主要な成果:
- 高SVR12率は,HCVの全ゲノタイプで観察されました:ゲノタイプ1 (治療未経験) の76%で,ゲノタイプ2の88%で,ゲノタイプ3 (治療未経験) の67%で.
- HCVゲノタイプ2または3の治療経験のある患者は,高いSVR12比率 (それぞれ92%,94%) を示しました.
- 一般的な有害事象には,疲労,不眠,吐き気が含まれ,有害事象のために治療を中止したのは3%のみで,HIV状態には影響はありません.
結論:
- ソフォスブウィールとリバビリンの経口投与によるインターフェロンなしの組み合わせは,HCV-HIV共感染患者のHCV撲滅に高い有効性を示しています.
- このレジミンは,HCV-HIV共感染者に対して有望な治療選択肢を提供しており,多様な集団でのさらなる調査を正当化しています.
- 治療はよく耐えており,HIV疾患の進行や管理に悪影響を及ぼしませんでした.
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