Treatment of Chronic HCV Infection in Special Populations

Abstract

The mainstay of treatment of chronic hepatitis C is pegylated interferon combined with ribavirin and more than 50% of naïve patients will have viral cure with either 6 months (genotypes 2 and 3) or 12 months (genotypes 1,4, and 6) with the initial treatment. However, populations have been defined that respond less well to routine treatment including African Americans, immune suppressed populations, obese patients and cirrhotic patients. These types of patients are enriched in groups of patients who are non-responders to treatment. This article discusses viral kinetics that may impact treatment response, strategies to maximize treatment effectiveness in these populations and the treatment of nonresponders in general. Early viral kinetics can be used to define response or non-response and these results can be used to modify subsequent treatment length and dose.

Very Low Viral Load (VLVL) Relapse Following Treatment of Naïve Patients with Chronic Hepatitis C

“…The overall SVR in the 15 patients given re-treatment in this study was 8/15 (55%) which is similar to that reported in the literature for relapse patients [18][19][20][21]. However, we had five patients with VLVL relapse and one additional patient that had persistent viral suppression post treatment compared with baseline.…”

“…They were typical of relapse patients with increase in RNA back to baseline within 3 months of stopping treatment. Subsequently, these VLVL relapse patients [13][14][15][16][17][18][19][20][21], had an unexpected result with decrease in RNA at 6 months after The patients with VLVL relapse had a lower baseline viral RNA level than the other relapse patients, but were otherwise similar in their initial response to treatment * RVR rapid virologic response, EVRc early virologic response complete, Mon month stopping treatment to \5,000 IU/ml followed by a sustained low HCV RNA level in blood that remained \1/10 the initial baseline level for at least 6 more months (most patients with HCV RNA \1/100 baseline). They also had a high incidence of cirrhosis, significantly lower baseline HCV RNA, and less frequent RVR than the non-VLVL relapse patients.…”

“…SVR is less likely when treatment of genotype 1 patients is shortened to 6 months [16]. Patients with virologic relapse to the initial treatment have a greater re-treatment SVR than non-responders although usually requiring higher dose or a longer treatment period for a maximum SVR [18][19][20][21]. The need for re-treatment is greater in the setting of cirrhosis, but the response is lower [18][19][20][21].…”

Efficacy of antiviral therapy in patients with hemophilia and hepatitis C virus infection

“…Lecenje hernofilicara sa HCV infekcijom se bitno ne razlikuje ad lecenja ove monoinfekcije kod drugih bclesnika [8]. Stabilan virusoloski odgovor .Ie nizi kod osoba sa hemofilijom koje pored HCV infekcije imaju pridruzenll HIV in-fekciJu [14]. Ima podataka da je 6 rneseci nakon zavrsetka lecenja stabilan virusoloski odgovor registrovan kod 63% svih ispitivanih bolesnika.…”

Cyclophilin Inhibitors

“…1,[13][14][15][16][17][18][19][20] For example, response rates in African American patients with genotype 1 HCV have been shown to be as low as 6% to 26%, and 50% in those with genotypes 2 or 3. 16,17 This is compared with overall cure rates of 45% to 55% for genotype 1 and more than 75% to 80% in genotypes 2 and 3 for non-Hispanic whites.…”