Hepatitis C virus therapy with peg-interferon and ribavirin in Myanmar: A resource-constrained country

Abstract

AIMTo investigate peg-interferon (peg-IFN) and ribavirin (RBV) therapy in Myanmar and to predict sustained virologic response (SVR).METHODSThis single-center, open-label, study was conducted in Myanmar between 2009 and 2014. A total of 288 patients infected with HCV genotypes 1, 2, 3 and 6 were treated with peg-IFN alpha-2a (180 μg/wk) or alpha-2b (50 to 100 μg as a weight-based dose) and RBV as a weight-based dose (15 mg/kg/d). Treatment duration was 48 wk for genotypes 1 and 6, 24 wk for genotype 2, and 24 or 48 wk for genotype 3 based on rapid virologic response (RVR). Those co-infected with hepatitis B received 48 wk of therapy.RESULTSOverall, SVR was achieved for 82% of patients and the therapy was well tolerated. All patients achieved SVR at equivalent rates regardless of HCV genotype (P = 0.314). Low fibrosis scores (P < 0.001), high baseline albumin levels (P = 0.028) and low baseline viral loads (P = 0.029) all independently predicted SVR. On the other hand, IL-28B TT and CC genotypes were not found to significantly predict SVR (P = 0.634; P = 0.618). Among those who completed treatment, the occurrence of RVR showed a > 96% positive predictive value for achieving SVR. Treatment duration did not significantly impact the likelihood of achieving SVR for patients infected with genotype 3 HCV (P = 0.371). The most common adverse events were fatigue (71%) and poor appetite (60%). Among patients with genotype 3 HCV, more patients in the 48-wk treatment group required erythropoietin than in the 24-wk treatment group (61.1% vs 49.2%).CONCLUSIONSVR rates were high with peg-IFN and RBV therapy in Myanmar. Fibrosis scores, baseline albumin, HCV RNA levels and RVR independently predicted SVR.

Safety and efficacy of sofosbuvir‐based direct‐acting antiviral regimens for hepatitis C virus genotypes 1‐4 and 6 in Myanmar: Real‐world experience

“…In a previous study from Myanmar, a high proportion of patients reported adverse events after completing 24 or 48 weeks of PEG-IFN and RBV; patients commonly reported anaemia (72%), fatigue (71%), poor appetite (60%) and insomnia (39%). 15 This experience demonstrates that triple combination had a better safety profile compared to PEG-IFN+RBV combination therapy-presumably due to the shorter treatment duration of PEG-IFN and RBV.…”

“…Moreover, high fibrosis scores did not influence SVR among patients treated with triple combination therapy ( P =.19) (Table ). Historically, 24 or 48 weeks of PEG‐IFN+RBV combination therapy has yielded SVR rates of about 75‐90% across all HCV genotypes in Myanmar . Results from the NEUTRINO study showed SVR rates of 90% after 12 weeks of triple combination therapy for patients with genotypes 1 and 4‐6, and a significantly higher rate of SVR among patients without cirrhosis .…”

High sustained virologic response in genotypes 3 and 6 with generic NS5A inhibitor and sofosbuvir regimens in chronic HCV in myanmar

“…Since globally, HCV genotypes 1, 2 and 3 are most common, with genotype 1 accounting for 46% of cases, studies with large cohorts of genotype 6 patients are uncommon . However, these data are important because in South‐East Asia, where HCV infection rates are higher than in the Western World, the most common HCV genotypes are 1, 3 and 6 . In Myanmar, genotypes 3 and 6 are the most prevalent, accounting for the majority of HCV infections .…”

“…Nearly 2%‐12% of individuals in South‐East Asian countries are infected with HCV, while in Western countries, such as the United States, the rates are considerably lower (1.6%) . In addition, while globally the most common genotypes are 1, 2 and 3, in South‐East Asia genotypes 1, 3 and 6 are most prevalent . In Myanmar, genotype 6 has accounted for as high as 50% of all HCV infections, while the prevalence of genotype 1 has been as low as 11% .…”

Strategy and Efficacy of Generic and Pan-genotypic Sofosbuvir/Velpatasvir in Chronic Hepatitis C Virus: A Myanmar Experience

“…2,3 However, in Southeast Asia, the most common genotypes are 1, 3, and 6. 4 In Myanmar, in particular, genotype -6 is the most prevalent genotype, accounting for almost half of the HCV infections, while genotype -1 only accounts for 11% of the cases. 5 In order for HCV to be eradicated, rates of sustained virologic response (SVR) need to be higher than those of new HCV infections.…”