Using pegylated interferon alfa-2b and ribavirin to treat chronic hepatitis patients infected with hepatitis c virus genotype 1: are nonresponders and relapsers different populations?

Abstract

The combination of pegylated interferon (PEG-INF) and ribavirin is currently the best treatment for chronic hepatitis C, providing a sustained virological response (SVR) in 54%-63% of patients. In patients infected with hepatitis C virus (HCV) genotype 1, the SVR rate is 42%-52%. To evaluate the treatment efficacy of this drug combination, we conducted an open, prospective study of 58 consecutive treatment-naïve patients infected with HCV genotype 1 and treated at a university hospital, comparing those presenting an SVR (SVRs), nonresponders (NRs), and relapsers (RELs). Among the intent-to-treat patients, an end-of-treatment virological response was achieved in 69% of the sample as a whole and in 52% of the SVRs. We found that being an SVR was significantly associated with mild fibrosis (p = 0.04) and with undetectable HCV RNA at weeks 12 and 24 of treatment (p < 0.0001). Comparing the SVR and REL groups, we observed that being older than 40 was significantly associated with being a REL (p = 0.04). Being an NR was found to be associated with severe fibrosis and moderate inflammatory infiltrates (portal or periportal). In the polytomous logistic regression, no independent factors were associated with the REL group when compared with the SVR group. We conclude that RELs and NRs differ in comparison with SVRs. The RELs accounted for 17% of the sample. The HCV RNA test results at weeks 12 and 24 of treatment, although independent predictors of non-response (OR: 4.8 and 8.2, respectively), did not differ between SVRs and RELs.

Assessment of the treatment of chronic hepatitis C in the state of Mato Grosso, central Brazil

“…Some of the characteristics of the sample, such as age and the preponderance of both male subjects and genotype 1, demonstrate that the present sample is similar to those from other series of clinical cases, which corroborates the results found and reduces the chance of a selection bias resulting from the loss of data (Zeuzem et al 2000, Alves et al 2003, Figueiredo-Mendes et al 2003, Gonçales et al 2006, Parise et al 2006, Silva et al 2007, Vigani et al 2008, Almeida et al 2009, McHutchison et al 2009). Regarding genotype in particular, previous studies had already demonstrated that genotype 1 is predominant in MT, as it is in most of Brazil (Campiotto et al 2005).…”

“…The SVR rate of 32.6% was lower than that observed in prospective studies, which report an SVR of approximately 50% (Manns et al 2001, Fried et al 2002, Brandão et al 2006, Gonçales et al 2006, Silva et al 2007), but similar to that observed in several retrospective studies in the country (Alves et al 2003, FigueiredoMendes et al 2003, Acras et al 2004, Vigani et al 2008, Almeida et al 2009). These numbers suggest that in real-life conditions, the results obtained by the Brazilian healthcare services are not comparable to the results obtained in controlled trials, a fact that should be addressed by the country's public health authorities.…”

“…Other national and international studies describe an incidence of cirrhosis ranging from 12-27% (Manns et al 2001, Fried et al 2002, Alves et al 2003, FigueiredoMendes et al 2003, Gonçales et al 2006 . TABlE III Multivariate analysis of the influencing factors on the sustained virological response (SVR) in the treatment of hepatitis C patients in the state of Mato Grosso, Brazil, considering only therapy regimens using ribavirin (RBV) and patients not infected with human immunodeficiency virus (HIV) or with chronic renal failure 2006, Silva et al 2007, Vigani et al 2008, Almeida et al 2009). Cirrhosis was one of the most important factors associated with treatment failure in our study, with only 15.2% of cirrhotic patients achieving an SVR (Table II).…”

“…In the past few years, some studies have been published in the Brazilian medical literature describing the experiences of different healthcare service providers In Brazil, the treatment of hepatitis C virus (HCV) (OR: 5.3;CI 95%: 1.7,16.7) and uninterrupted treatment (OR: 9.0;CI 95%: 3.3,45.4 with the treatment of chronic hepatitis C in Brazil (Alves et al 2003, Figueiredo-Mendes et al 2003, Acras et al 2004, Brandão et al 2006, Gonçales et al 2006, Parise et al 2006, Silva et al 2007, Vigani et al 2008, Almeida et al 2009). These reports include experiences in the South and Southeast Regions of the country.…”

Gender influence on treatment of chronic hepatitis C genotype 1

“…In a retrospective study on Southern Brazilian patients with chronic hepatitis and HCV genotype 1 infection, SVR was achieved in only 35.3% of patients (114/323), although this may have occurred because a large proportion of the patients presented advanced fibrosis (F3/F4 = 74%) 24 . However, previous Brazilian studies have demonstrated SVR rates of 44-52% in genotype 1 HCV infection among patients who were not enrolled in medical trials [25][26][27] . Improvements in the management of patients with chronic HCV genotype 1 infection are essential.…”