Response to treatment with interferon-alpha and ribavirin in patients with chronic Hepatitis C virus genotypes 2 and 3 depends on the degree of hepatic fibrosis

Abstract

The combined therapy with interferon alfa plus ribavirin (INF+RBV) is considered the most appropriate treatment for patients with chronic hepatitis C virus genotypes 2 and 3 in Brazil. However, wide variations in the rates of sustained viral response (SVR) have been reported among such patients. We evaluated, retrospectively, factors associated with SVR in subjects with chronic hepatitis C virus genotypes 2 and 3 and that received medication from the Health Secretariat of the state of São Paulo. One-hundred-seventy-seven consecutive patients with chronic hepatitis C were treated for 24 or 48 weeks according to the viral genotype. Patients co-infected with associated hepatic diseases or who had problems with alcohol abuse were excluded. The genotype of the HCV-RNA was identified through restriction analysis, the viral load through quantitative PCR (Amplicor, Roche) and the degree of hepatic fibrosis according to the Metavir score. Demographic, virological and histological parameters were submitted to binary logistic regression analysis to identify the variables associated with SVR. The overall rate of SVR was 36.4% for the 177 patients, and genotype 2 or 3 was the main parameter independently associated with SVR. Among the 77 patients with these viral genotypes, only the stage of fibrosis had a significant effect on the SVR (odds ratio (OR) = 3.035; 95% CI (confidence interval) = 1.196-7.699; p=0.019). The rate of SVR among the subjects with fibrosis at an advanced stage (F3-F4) was 38%, compared to 75% for patients with fibrosis at an initial stage (F0-F2). Consequently, other therapeutic options should be considered for patients with genotypes 2 and 3 who have advanced fibrosis.

Therapeutic effectiveness of biosimilar standard interferon versus pegylated interferon for chronic hepatitis C genotypes 2 or 3

“…5,6,13,14 in Brazil, previous studies in patients with genotype 2 or 3 treated with biosimilar standard ifn plus RBV showed SVR rates ranging from 39 to 46%, similar to that found in the present study. [15][16][17] on the other hand, one Brazilian study on patients with genotypes 2 or 3 infections who were treated with Peg-ifn plus RBV found a SVR rate of 67%. 18 Biosimilar standard ifn plus RBV treatment is routinely used in Brazilian patients with genotype 2 or 3 infections and, according the present study findings, it was less effective regarding SVR than what would be expected according to the literature.…”

Astragalus and Paeoniae Radix Rubra extract (APE) inhibits hepatic stellate cell activation by modulating transforming growth factor-β/smad pathway

“…This leads to liver cirrhosis and, ultimately, to liver carcinoma ( 4 ). Although numerous therapeutic options are currently available for liver fibrosis, all have limited degrees of success and none were capable of producing a complete cure ( 5 ). Thus, there is an urgent need to develop better preventative options as well as treatment approaches, based on a more thorough understanding of the pathogenesis of hepatic fibrosis.…”

Chronic Hepatitis C treatment for genotype 2 or 3 in Brazil: cost effectiveness analysis of peginterferon plus ribavirin as first choice treatment

“…On the other hand, patients with advanced stage fibrosis had low rates of response to this combined therapy, and a criterion of treatment with pegylated interferon as a first alternative should be considered (Parise et al, 2006). Despite this considerations we don't do sub analysis considering the degree of hepatic fibrosis.…”

“…SVR rates in individual studies in Brasil to Non-HIV naïve patients with HCV genotype 2 or 3 who underwent treatment with IFN plus RBV for 24 weeks varied from 33% to 80% (Alves, De Azevedo et al, 2003;Acras, Pedroso et al, 2004;Borges, 2004;Villela-Nogueira, Perez et al, 2005;Parise, De Oliveira et al, 2006;Fachini, 2008;Almeida et al, 2009;Carneiro et al, 2010;Vigani et al, 2012). SVR rates from this Brazilian studies are very different from each other and below the main clinical trials found in literature (Manns et al, 2001).…”