Response Guided Interferon Therapy for Genotype 3 of Chronic Hepatitis C: Compliance and Outcome

Abstract

Objective:To determine compliance and improvement in sustained viral response (SVR) by following response guided therapy (RGT) plan of interferon and ribavirin, for genotype 3 in chronic hepatitis C.Methods:Patients with chronic hepatitis C genotype 3, who were eligible for interferon-ribavirin therapy and consented for RGT, were included. Those with no rapid viral response (RVR), having coarse echotexture of liver or undergoing re-treatment, were advised 48 week treatment whereas, rest had 24 week standard therapy. PCR for HCV RNA checked 6 months after discontinuing treatment, was the primary end point of study.Results:Of 154 patients, included in the study with mean age of 39.9 (±10.84) and male to female ratio 1.4/1 (94/60), majority of patients, 136 (88.4%) were treatment naïve whereas, 18 (11.6%) were being retreated. On ultrasound, 63 (40.9%) patients had coarse liver and 33 (21.4%) had splenomegaly. RVR was achieved in 99 (64.3%) patients. Overall 66(42.8%) patients merited extended duration of therapy as per RGT plan but only 22 (33%) were compliant. Treatment related side effects were the dominant reason for declining RGT in 33 (75%) patients. SVR was noted in 111 (72.1%) patients. Those patients with extended therapy (RGT), had SVR 90.9% (20/22), although, better but statistically not significant than those who stopped therapy at 6 months 77.2% (34/44) (p value 0.11).Conclusion:Response guided therapy plan did not improve SVR to pegylatedinterferon and ribavirin therapy in patients with genotype 3 and it has low patient compliance due to treatment related side effects.

Resistance analysis of genotype 3 hepatitis C virus indicates subtypes inherently resistant to nonstructural protein 5A inhibitors

“…Despite this dramatic increase in effectiveness of DAA treatment for chronic HCV infection, the treatment of genotype 3 (gt3) infection has shown lower SVR rates compared to other genotypes, especially in patients with cirrhosis . This contrasts with the treatment of gt3‐infected individuals with interferon‐based therapy in whom SVRs were consistently higher than in those with gt1 . More recently, pan‐genotypic regimens have been developed that very effectively target HCV gt3 …”

In Vitro Study on Anti-Hepatitis C Virus Activity of Spatholobus suberectus Dunn

“…Chronic HCV infection is a major cause of severe liver diseases, including liver fibrosis/cirrhosis and cancer. Despite the recent success of HCV treatments with DAAs alone or in combination with pegIFNα/ribavirin, alternative treatment methods should be further developed for certain patients groups, such as those with genotype 3, renal failure, hepatic decompensating, and liver transplantation [43,44]. In addition, high risk populations with low income have limited access to DAAs because of high costs.…”