Hepatitis C Virus Genotype 4 and Response to Combination Therapy with Interferon-α2b plus Ribavirin

Bruno, Savino; Crosignani, Andrea; Pinzello, G

doi:10.7326/0003-4819-133-11-200012050-00025

Cited by 6 publications

(3 citation statements)

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“…The prevalence of HCV antibody positivity in Saudi Arabia ranges from 1% to 3%,1617 with genotype 4 representing 60% to 70% of these infections 18–21. There are limited reports on the treatment of chronic HCV-4 patients from the Middle East (mainly from Saudi Arabia, Egypt, Kuwait, and Qatar),22–31 or elsewhere 32–35. All these studies were heterogeneous and were weakened by small numbers of patients, the use of conventional interferon with or without RBV, different durations of therapy, the inclusion of patients co-infected with human-immunodeficiency virus (HIV), the lack of liver histopathology data and by the absence of data assessing the predictors of SVR.…”

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confidence: 99%

Predictors of sustained virological response to a 48-week course of pegylated interferon alfa-2a and ribavirin in patients infected with hepatitis C virus genotype 4

Ashgar

Helmy

Khan

et al. 2009

Annals of Saudi Medicine

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BACKGROUND AND OBJECTIVES:Knowledge of the predictors of sustained viral response (SVR) to pegylated interferon (PEG-INF) alfa-2a and ribavirin (RBV) therapy in patients with hepatitis C genotype-4 (HCV-4) is crucial for selecting patients who would benefit most from therapy. We assessed the predictors of SVR to this combination therapy in Saudi patients with chronic HCV-4 infection.PATIENTS AND METHODS:This retrospective study included 148 patients with HCV-4 infection who underwent clinical, biochemical and virological assessments before treatment and at 12, 24, 48 and 72 weeks post-treatment.RESULTS:Of the 148 patients, 90 (60.8%) were males. Mean (SD) for age was 48.5 (12.7) years and BMI was 27.9 (7.5) kg/m2. Seventy-nine of 148 (60.1%) patients were treatment naïve and 110 (74.3%) underwent pre-treatment liver biopsy. Eighteen (12.2%) patients did not complete therapy because of side effects or they were lost to follow up. Early virological response was achieved in 84 of 91 (92.3%) patients. In the 130 (87.8%) patients who completed therapy, 34 (26.2%) were non-responders and 96 (63.8%) achieved end-of-treatment virological response (ETVR). SVR and virological relapse (24 weeks after ETVR) occurred in 66/130 (50.7%) and 30/130 (31.2%) patients, respectively. Compared to relapsers, sustained responders were significantly younger (P=.005), non-diabetic (P=.005), had higher serum albumin (P=.028), lower alpha-fetoprotein level (P=.026), lower aspartate aminotransferase (AST) (P=.04) levels, and were treatment-naivve (P=.008). In a multivariate regression analysis, the independent predictors of SVR were younger age (P=.016), lower serum AST (P=.012), and being treatment naivve (P=.021).CONCLUSION:Approximately half of HCV-4 patients who complete the course of combination therapy achieve an SVR, especially if they are young, treatment naivve and have lower AST levels.

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confidence: 99%

Predictors of sustained virological response to a 48-week course of pegylated interferon alfa-2a and ribavirin in patients infected with hepatitis C virus genotype 4

Ashgar

Helmy

Khan

et al. 2009

Annals of Saudi Medicine

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“…[12–22] Other studies performed on genotype 4 patients outside the Middle East are subject to the same limitation. [23–25]…”

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Sustained virologic response to peginterferon α-2a and ribavirin in 335 patients with chronic hepatitis C: A tertiary care center experience

Ashgar

Khan

Helmy

et al. 2008

Saudi J Gastroenterol

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Background/Aim:This retrospective study assessed the efficacy, safety, and the predictors of sustained viral response (SVR) to a 48-week-course of peginterferon α-2a (Pegasys) and ribavirin combination therapy in 335 consecutive Saudi patients with chronic hepatitis C virus (HCV) infection.Materials and Methods:Clinical, biochemical, and virological parameters were collected at time 0 (pretreatment) and at 12, 24, 48, and 72 weeks posttreatment. The mean ± SD age was 49.1 ± 13.0 years; 229 (68.4%) were males, mean ± SD body mass index was 27.8 ± 7.4, 85 (25.4%) were diabetic, 25 (7.5%) had renal impairment, 136 (40.6%) had previously received interferon ± ribavirin therapy, and 247 (73.7%) underwent pretreatment liver biopsy. Patients with genotypes 1, 2 or 3, 4 and mixed genotype were 60 (22.15%), 30 (11.0%), 148 (54.4%), and 34 (12.5%), respectively.Results:Early viral response (≥2-log10 HCV-RNA decline 12 weeks posttreatment) was achieved in 253 (75.3%). Patients who completed 48 weeks of treatment were 292 (87.1%); of these, 121 (75.6%) achieved ETVR, 161 (55.1%) continued to have SVR and 60 (20.5%) had a viral relapse following end-of-treatment response, that is 48.1 and 17.9% of all patients (n = 335), respectively. Nonresponders (NR) were 71 (24.3%) patients and 43 (12.8%) were unable to complete treatment (due to side effects or loss to follow up). Compared to the relapsers, patients with SVR were significantly younger (P = 0.000), nondiabetics (P = 0.015), had higher serum albumin (P = 0.007), had less pretreatment inflammatory grade (P = 0.011), infected with genotypes 2 or 3 (P = 0.014), and treatment-naïve patients (P = 0.001). However, in stepwise multivariate logistic regression analysis, only treatment naiveté and low pretreatment inflammatory score were the independent predictors of SVR (P = 0.005 and P = 0.018, respectively).Conclusion:Combination therapy, if tolerated and completed, is effective in treating chronic HCV patients, especially those with no previous interferon therapy and lower pretreatment inflammatory grade.

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“…A small Italian study reported on 18 HCV4 patients treated with IFN‐α‐2b 5–6 MU TIW plus ribavirin 1000–1200 mg/day for 48 weeks 45 . Three patients had cirrhosis and seven had been treated previously with IFN monotherapy.…”

Section: Treatmentmentioning

confidence: 99%

Management of hepatitis C virus genotype 4

Abdo

Lee

2004

J of Gastro and Hepatol

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Hepatitis C virus (HCV) genotype 4 is predominantly found in the Middle East and North Africa. Because most of the large randomized controlled trials of antiviral therapy for chronic hepatitis C were conducted in North America and Europe, little is known about management of patients with this particular genotype. Based on the available data, sustained virological response rates to interferon-based therapies appear to be intermediate between the relatively resistant HCV genotype 1 and the readily responsive genotypes 2 and 3. Several large prospective studies of pegylated interferon plus ribavirin combination therapy, the current gold-standard treatment, have recently been completed and will be reviewed.

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Hepatitis C Virus Genotype 4 and Response to Combination Therapy with Interferon-α2b plus Ribavirin

Cited by 6 publications

References 3 publications

Predictors of sustained virological response to a 48-week course of pegylated interferon alfa-2a and ribavirin in patients infected with hepatitis C virus genotype 4

Predictors of sustained virological response to a 48-week course of pegylated interferon alfa-2a and ribavirin in patients infected with hepatitis C virus genotype 4

Sustained virologic response to peginterferon α-2a and ribavirin in 335 patients with chronic hepatitis C: A tertiary care center experience

Management of hepatitis C virus genotype 4

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