Update der S 3-Leitlinie Prophylaxe, Diagnostik und Therapie der Hepatitis-C-Virus(HCV)-Infektion, AWMF-Register-Nr.: 021 / 012

Sarrazin, C.; Berg, T.; Roß, R. Stefan; Schirmacher, Peter; Wedemeyer, Heiner; Neumann, UP; Schmidt, Holger; Spengler, Ulrich; Wirth, Stéfan; Hh, Kessler; Peck‐Radosavljevic, Markus; Ferenci, Péter; Vogel, Wendy H; Moradpour, Darius; Heim, Markus H.; Cornberg, Markus; Protzer, Ulrike; Manns, Michael P.; Fleig, Wolfgang E.; Dollinger, Matthias; Zeuzem, S.

doi:10.1055/s-0028-1110008

Cited by 144 publications

(53 citation statements)

References 237 publications

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“…Treatment algorithms have been similar for GT2 and GT3 in German, EASL and AASLD guidelines recommending PEG-IFN and RBV at a flat dose of 800 mg/day for 24 weeks [1]–[3]. Studies with DAAs have been successful for GT2, whereas SVR appears to be lower in GT3 [25]–[36].…”

Section: Discussionmentioning

confidence: 99%

“…There is still a controversy which subgroups of GT2 and GT3 patients need a shortened or prolonged therapy and RBV dosing adapted to body weight [13], [33]–[35]. There is some agreement that treatment shortening should be reserved to patients with RVR and low baseline viral load and that prolongation to those without RVR and with further negative predictive factors [1]–[3], [8], [14]. In previous studies lack of fibrosis predicted SVR, as well as young age and a HCV-RNA <400,000–600,000 IU/ml [5]–[11].…”

Section: Discussionmentioning

confidence: 99%

“…SVR was defined as negative HCV-RNA 24 weeks after end of treatment. The response definitions were the ones used in German and US guidelines [1], [3], [20]. We are aware that in the recent EASL guideline [2] EVR is defined differently as a HCV-RNA detectable at week 4, but undetectable at week 12.…”

Section: Methodsmentioning

confidence: 99%

“…Values <0.5 exclude significant fibrosis, values between 0.5–1.5 are associated with mild fibrosis and values>1.5 with severe fibrosis or cirrhosis [21]–[24]. For duration of therapy three categories were used: a) <22 weeks, b) 22–26 weeks, and c)>26 weeks [1]–[3].…”

Section: Methodsmentioning

confidence: 99%

“…Previous trials combined genotype 2 (GT2) and GT3 patients as an “easy to treat” group and guidelines recommend similar treatment for both genotypes [1]–[11]. Recently it has been suggested that the two genotypes differ and need more specific management [12]–[16].…”

Section: Introductionmentioning

confidence: 99%

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Predictive Factors for Sustained Virological Response after Treatment with Pegylated Interferon α-2a and Ribavirin in Patients Infected with HCV Genotypes 2 and 3

et al. 2014

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BackgroundPrevious trials have often defined genotype 2 and 3 patients as an “easy to treat” group and guidelines recommend similar management.AimsThe present study looks for differences between the two genotypes and analyzes predictive factors for SVR.MethodsProspective, community-based cohort study involving 421 physicians throughout Germany. The analysis includes 2,347 patients with untreated chronic HCV genotype 2 (n = 391) and 3 (n = 1,956) infection treated with PEG-IFN α-2a plus ribavirin between August 2007 and July 2012.ResultsWhen compared with genotype 2 patients, those with genotype 3 were younger, had a shorter duration of infection, lower values of total cholesterol, LDL cholesterol and BMI, a higher frequency of drug use as infection mode and male gender (p<0.0001, respectively), and a higher APRI score (p<0.005). SVR was higher in genotype 2 when compared with genotype 3 (64.7% vs. 56.9%, p = 0.004). By multivariate analysis of genotype 2 patients, low baseline γ -GT and RVR predicted SVR. In genotype 3 age ≤45 years, cholesterol>130 mg/dl, a low APRI score, and a γ-GT ≥3-times ULN, RVR, and RBV starting dose were associated with SVR by multivariate analysis.ConclusionsThe present study corroborates that liver fibrosis is more pronounced in genotype 3 vs. 2. SVR is higher in genotype 2 versus genotype 3 partly because of follow-up problems in genotype 3 patients, in particular in those infected by drug use. Thus, subgroups of genotype 3 patients have adherence problems and need special attention also because they often have significant liver fibrosis.Trial RegistrationVerband Forschender Arzneimittelhersteller e.V., Berlin, Germany ML21645 ClinicalTrials.gov NCT02106156

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictive Factors for Sustained Virological Response after Treatment with Pegylated Interferon α-2a and Ribavirin in Patients Infected with HCV Genotypes 2 and 3

et al. 2014

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Individually Tailored Treatment Strategies in Treatment‐naïve Chronic Hepatitis C Genotype 1 Patients

Berg¹

2011

Advanced Therapy for Hepatitis C

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Improvement of neurocognitive function in responders to an antiviral therapy for chronic hepatitis C

et al. 2013

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Earlier studies have suggested neurocognitive impairment in patients with chronic hepatitis C virus (HCV) infection even before liver cirrhosis has developed. Since these deficits might be reversible after successful antiviral therapy, we analyzed the long‐term course of neurocognitive parameters in HCV patients with and without successful virus elimination by an interferon‐based antiviral treatment. In a multicenter study including 168 HCV patients receiving antiviral therapy (peginterferon alpha‐2b and ribavirin) we performed a long‐term follow‐up of neurocognitive performance before and after treatment. Neurocognitive function was psychometrically assessed using the computer‐aided TAP (Test Battery of Attentional Performance). When tested at least 12 months after termination of antiviral treatment, patients with sustained virologic response (SVR) had improved significantly as compared to their pretreatment performance in three of five TAP subtasks (vigilance, P < 0.001; shared attention: optical task, P < 0.001; working memory, P < 0.001). Patients who failed to eradicate the virus, however, showed no significant long‐term changes in neurocognitive performance in all five subtasks assessed (0.194 < P < 0.804). In the posttreatment evaluation, neurocognitive function was significantly better in responders to the antiviral therapy as compared to nonresponders. Conclusion: Successful eradication of HCV leads to a significant improvement of relevant aspects of attentional and neurocognitive performance, indicating that the neurocognitive impairment caused by chronic HCV infection is potentially reversible. This therefore suggests an added therapeutic benefit of antiviral treatment in HCV infection. Improvement of neurocognitive function may be an additional treatment indication in patients with HCV. (HEPATOLOGY 2013;58:497–504)

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Update der S 3-Leitlinie Prophylaxe, Diagnostik und Therapie der Hepatitis-C-Virus(HCV)-Infektion, AWMF-Register-Nr.: 021 / 012

Cited by 144 publications

References 237 publications

Predictive Factors for Sustained Virological Response after Treatment with Pegylated Interferon α-2a and Ribavirin in Patients Infected with HCV Genotypes 2 and 3

Predictive Factors for Sustained Virological Response after Treatment with Pegylated Interferon α-2a and Ribavirin in Patients Infected with HCV Genotypes 2 and 3

Individually Tailored Treatment Strategies in Treatment‐naïve Chronic Hepatitis C Genotype 1 Patients

Improvement of neurocognitive function in responders to an antiviral therapy for chronic hepatitis C

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