Predictors of early and sustained virological response of viral hepatitis C

Abstract

Due to complex interplay between host and viral factors, pathogenesis of chronic hepatitis C (CHC) is considered a challenging issue. Infection with hepatitis C virus (HCV) is not confined only to liver but can induce disturbances in many other organs and systems. Our primary aim for this study was to evaluate biological response rates and sustained virological response (SVR) in patients diagnosed with CHC, treated with Interferon-alpha (IFN-α), Pegylated (PEG)-IFN-α2a or -α2b plus Ribavirin. The second aim of the study was the identification of predictive factors for a favorable response to antiviral therapy in patients diagnosed with CHC. We enrolled in this study 210 patients diagnosed with CHC who have accomplished all inclusion and exclusion criteria, treated with PEG-IFN plus Ribavirin. Patients' recovery progress has been evaluated by determining: age, gender; biochemical tests: alanine aminotransferase (ALT), aspartate aminotransferase (AST); serological assays -detect anti-HCV antibody and molecular assays -detect, quantify and/or characterize hepatitis C viral load (ribonucleic acid) (HCV-RNA); liver histopathological (HP) examination. According to their response to treatment, they were classified into responders (n=145) and non-responders (n=65). Liver biopsies were histopathologically evaluated for necroinflammatory grade and fibrosis stage according to the modified Ishak and Metavir scoring systems for chronic hepatitis. Demographic, laboratory, and HP results were introduced in statistical analysis. These parameters were included in area under curve (AUC) analysis in order to estimate their degree of influence on getting early virological response (EVR) and SVR. Our study demonstrates that factors connected to treatment failure in CHC are linked to older age, high hepatitis C viral load, and impaired glucose tolerance at beginning of treatment [high fasting glucose and insulin, high homeostatic model assessment of insulin resistance (HOMA-IR) index] and also to liver histology features (high fibrosis score, liver steatosis, iron infiltration, and more or less high necroinflammatory activity). Analyzing results of our study shows that HOMA-IR index, serum insulin levels, baseline HCV-RNA, baseline mean blood glucose and HP score like Ishak fibrosis score, steatosis score and liver iron score may have a predictive value for obtaining an EVR in patients diagnosed with CHC.

Seroprevalence of hepatitis C virus antigen in patients with chronic liver disease and hepatocellular carcinoma at 12th week of treatment: a cross-sectional study

“…Indeed, it is known that the treatment of hepatitis C using DAAs very rarely eliminates HCV in all people treated. This is probably due to certain risk factors such as on the one hand the advanced age and health status of the patient and on the other hand, the cost, the duration, and the missed doses can negatively affect the results of the treatment [ 23 , 26 - 28 ]. Added to this, the lack of inexpensive viral diagnostic tests and universally accessible treatment adapted to resource-limited settings represent an obstacle to the implementation of HCV surveillance in difficult contexts [ 22 ].…”

Diagnostic and prognostic significance of hepatic steatosis in patients with chronic hepatitis C

“…The main risk factors of the host, which contributed to the appearance of HS were age, sex, body weight, BMI, and personal pathological history. In patients with CHC, in whom insulin resistance plays an important role, HS may be due to high BMI, obesity, hyperlipidemia, metabolic syndrome, and diabetes mellitus [ 19 ]. In the CHC studied patients, the mean age of those with HS was significantly higher than the mean age of patients without HS.…”

“…This association was even stronger after excluding patients with liver cirrhosis ( p <0.0001) [ 42 ]. Finally, there are authors who have mentioned that in patients with HCC, the clinical significance of HS involves an association between liver fibrosis and an unsatisfactory response to combination antiviral therapy with Pegylated Interferon (PEG–IFN) and Ribavirin [ 19 ].…”

Hepatitis C: sociodemographic and clinical profile of patients treated with direct-acting antivirals in a pharmaceutical office

“…Although viral load is considered an important prognostic factor in determining treatment, the relationship between viral load, genotype, and disease progression remains controversial (Basharkhah et al, 2019). Factors related to treatment failure in CHC are related to older age, high hepatitis C viral load, and impaired glucose tolerance at the start of treatment (Ghenea et al, 2020).…”