Acute HCV: Will IL28B Testing Change the Paradigm?

Abstract

HCV infection will spontaneously resolve in 30% to 50% of patients. Patients with beneficial IL28B genotypes are more likely to clear spontaneously, while other are unlikely to, with less than 15% clearance rate. These patients would therefore be very likely to benefit from immediate treatment with pegylated interferon. In delayed treatment, ribavirin might be required to achieve similar results, making the delayed treatment also from the cost perspective only attractive in those likely to clear spontaneously: Patients with beneficial IL28B genotype and jaundiced patients with the intermediate IL28B genotype.

Treatment of Acute Hepatitis, Severe Acute Hepatitis, and Acute Liver Failure

“…These studies found a >50% spontaneous clearance rate in patients with a favorable IL28B genotype. This high spontaneous clearance rate suggests that IL28B can be helpful in individualizing treatment for patients with clinically evident acute hepatitis C [50]. Patients with an IL28B genotype (i.e., rs12979860 CC) that is more responsive to interferon, especially in the presence of jaundice, have a more than 50% chance of spontaneous viral clearance and can defer treatment as they are likely to respond to interferon-based therapy even if treatment is initiated at a later time point.…”