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目的 探讨人类免疫缺陷病毒(HIV)合并慢性丙型肝炎病毒(HCV)感染者使用普通干扰素治疗失败后改用聚乙二醇干扰素α(Peg-INF α)联合利巴韦林的疗效和安全性. 方法 前瞻性观察使用Peg-INF α联合利巴韦林,治疗20例普通干扰素治疗失败的HIV合并HCV感染者0(基线)、12、24、48周及停药后24周的HCV RNA载量、肝功能及CD4+计数变化.用t检验进行统计学分析.结果 20例患者HCV病毒基因分型:14例1b,3例2a,3例测序失败.基线情况:CD4+计数平均(406.45±210.83)个/μl;CD8+计数平均(1 076.45±716.18)个/μl;CD4+/CD8+比值平均0.43±0.17;HCV RNA平均载量(6.01±1.13)log10 IU/ml;12例(60％)存在肝功能异常.共14例(70％)患者获得完全早期病毒学应答(CEVR),15例(75％)获得治疗结束病毒学应答(ETVR),7例(35％)获得持续病毒学应答(SVR),8例(40％)复发.治疗过程中药物相关不良事件发生率为50％ (10/20),无严重不良事件发生,也无患者因为药物不良反应停药.20例患者治疗48周时的CD4+计数与CD8+计数,均较基线明显下降(P=0.001;P=0.001),但CD4+/CD8+比值明显升高(P=0.032).SVR组基线HCV RNA平均值(4.95±1.18) log10 IU/ml,未取得SVR组为(6.59±0.53) log10 IU/ml,前者明显低于后者(t=3.49,P=0.009).结论 HIV合并HCV感染者使用普通干扰素治疗失败后改用Peg-INFα联合利巴韦林仍可取得良好疗效和安全性,基线HCV RNA载量低者更容易获得SVR.“,”Objective To investigate the efficacy and safety of pegylated interferon-alpha (PEG-INF-α) combined with ribavirin in patients co-infected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) who failed prior standard interferon therapy.Methods A prospective study was performed to analyze HCV RNA load,liver function,and CD4+ count at weeks 0 (baseline),12,24,and 48 of treatment and at 24 weeks after drug discontinuation in 20 patients co-infected with HIV and HCV who failed standard interferon therapy and were then treated with PEG-INF-αt and ribavirin.Results Among the 20 patients,14 were infected with HCV genotype 1b,3 with HCV genotype 2a,and 3 failed sequencing.At baseline,the mean CD4+ count,mean CD8+ count,and mean CD4+/CD8+ ratio were 406.45 ± 210.83 cells/ ml,1 076.45 ± 716.18 cells/ml,and 0.43 ± 0.17,respectively;the mean HCV RNA load was 6.01 ± 1.13 log10 IU/ml;12 patients (60％) had abnormal liver function.A total of 14 patients (70％) achieved complete early virologic response,15 (75％) achieved end-of-treatment virologic response,7 (35％) achieved sustained virologic response (SVR),and 8 (40％) experienced recurrence.The incidence rate of drug-related adverse events during the treatment was 50％ (10/20);no serious adverse events occurred,and no patient withdrew from the treatment due to adverse events.At week 48,both CD4+ and CD8+ counts of all patients declined significantly compared with the baseline values (P =0.001 and 0.001),but the CD4+/CD8+ ratio increased significantly (P =0.032).The SVR group had a significantly lower mean baseline HCV RNA load than the non-SVR group (4.95 ± 1.18 log10 IU/ml vs 6.59 ± 0.53 log10IU/ml,t =3.49,P =0.009).Conclusion In the patients co-infected with HIV and HCV who failed standard interferon therapy,PEG-INF-α combined with ribavirin has good efficacy and safety,and the patients with a low baseline HCV RNA load are more likely to achieve SVR.