Predictors of response of U.S. veterans to treatment for the hepatitis C virus

Abstract

The currently recommended treatment for hepatitis C virus (HCV) infection is pegylated interferon alfa (PEG-INF) and ribavirin, which can be difficult to tolerate. More information about predicting sustained virologic response (SVR) may allow more informed treatment decisions to be made. This retrospective observational cohort study identified predictors of SVR to PEG-INF and ribavirin in routine medical practice at 121 Department of Veterans Affairs facilities. Among 5,944 patients infected with HCV genotypes 1, 2, or 3 who had been treated with PEG-INF and ribavirin, SVR rates were 20%, 52%, and 43%, respectively, and discontinuation rates were 68% (prior to 48 weeks), 34% (24 weeks), and 41% (24 weeks), respectively. In multivariate analysis, significant predictors of decreased likelihood of genotype 1 patients having an SVR were being African American, clinical liver disease, diabetes, low cholesterol, low hemoglobin, low platelet count, and treatment at a low-volume facility. Predictors of increased likelihood of genotype 1 patients having an SVR were low-level HCV viremia, elevated ALT quotient, and receiving PEG-INF 2A (rather than 2B). For genotype 2 patients, increasing body mass index, prior use of interferon, and low platelet count were negative predictors; only low-level HCV viremia was a positive predictor. For genotype 3 patients, only receiving PEG-INF 2A affected the likelihood of an SVR; its effect was positive. Conclusion: Among patients for whom HCV treatment is initiated during routine medical care, multiple factors including form of PEG-INF received affect the SVR rate for genotype 1 patients. Few of these factors affect the rate for genotype 2 patients, and even fewer do so for genotype 3 patients. (HEPATOLOGY 2007;46:37-47.)

Epoetin alpha improves the response to antiviral treatment in HCV-related chronic hepatitis

“…Moreover, in a retrospective observational cohort study of predictors of SVR to peg-IFN and RBV in routine medical practice at 121 Department of Veterans Affairs facilities, Backus et al identified, by univariate and multivariate analyses, the use of Epoetin Alpha as an independent predictor of SVR [51].…”

Placebo-controlled trial of 400 mg amantadine combined with peginterferon alfa-2a and ribavirin for 48 weeks in chronic hepatitis C virus-1 infection

“…28,29 This finding is also accordant with previous observations. 30 HCV RNA replication in vitro has been found to be dependent on intracellular lipid metabolism; however, influence of serum cholesterol levels on virological response to antiviral treatment in vivo has not yet been understood. 31,32 In conclusion, in this large placebo-controlled, doubleblinded multicenter study in patients with chronic hepatitis C, amantadine even at a dose of 400 mg/day was not able to improve virological response rates of PEG IFN-␣-2a and ribavirin.…”

Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation

“…With an estimated hepatitis C (HCV) seroprevalence of more than 5%, the Veterans Health Administration (VHA) is the largest single provider of medical care to people with HCV in the USA, yet fewer than 20% of VHA patients with HCV have been treated and less than half have accessed a liver specialist [1][2][3][4][5]. Low treatment rates combined with poor treatment response has resulted in a dramatic increase in the prevalence of HCV-infected veterans with cirrhosis and related sequelae, including a sixfold increase in hepatocellular carcinoma cases [6,7].…”