Response to pegylated interferon alfa‐2a and ribavirin in chronic hepatitis C genotype 4

Abstract

The safety and efficacy of pegylated interferon (PEG-IFN) alfa-2a and ribavirin were studied among patients treated for genotype 4 chronic hepatitis C. Ninety-five patients with chronic hepatitis C genotype 4 were treated with PEG-IFN alfa-2a (180 microg/week) plus ribavirin (> or =11 mg/kg/day) for 48 weeks. The primary end point was sustained virological response, defined as non-detectable levels of HCV RNA at the end of follow up (week 72). The proportion with sustained virological response was 58/95 = 61.1% (95% CI = 50.5-70.9%). Side effects were generally mild, well managed by dose reductions (in 62% of patients); in only two patients were side effects sufficiently severe to require treatment interruption. Ninety percent of patients adhered to treatment up to week 12, and their sustained virological response rate was higher compared to non-adherent (65% vs. 22%, respectively, P = 0.012). None of the patients who failed to achieve 1 log reduction of viral load by week 8 (n = 15), or 2 log reduction by week 12 (n = 17), had a sustained virological response. In conclusion, sustained virological response in genotype 4 Egyptian patients treated with PEG-IFN alfa-2a and ribavirin was estimated around 60%, intermediate between sustained virological response observed in genotype 1 and genotype 2-3 patients in Western countries. The early virological response (week 4 or week 8) should be investigated as a criterion to decide whether the patient may benefit from a shorter duration of therapy.

Does HCV Patients Who Have BCL2 43Ala Genotype and Normal GH1 Levels Can Achieve Response to IFN Based Therapy?

“…It is likely that the Ala43Thr polymorphism arose spontaneously in Asians/Japanese after the human ancestor population separated into Caucasians and Asians in the early history of Man. The current study found that NR have higher viral load and higher grade of liver activity and fibrosis than in responders but with no significant differences which agree with previous studies on HCV genotype-4 [24,25]. On the contrary, several studies have shown that high viral load and high grade of liver activity and fibrosis are negatively related with sustained virological response to interferon treatment [26,27].…”

Genotype 4 Hepatitis C Virus Responds Worse than Genotype 1 to 48-Week Combination Treatment with Pegylated Interferon Alpha Plus Ribavirin: a Greek Multi-Centered Study

“…Data for the efficacy of standard combination therapy with Peg-IFNα plus ribavirin in genotype 4 comes mainly from endemic areas such as Egypt [8,9,12,14], Saudi Arabia [10], Kuwait [13] and Quatar [11]. The reported SVRs range between 59.7 and 67.8%.…”

“…Data on the efficacy of current combination therapy with pegylated interferon-α (Peg-IFNα) plus weight-based ribavirin is limited and contradictory; sustained virological response (SVR) rates of more than 60% reported in endemic areas [8][9][10][11][12][13][14] are approximately two times higher than those encountered in Europe [15][16][17]. In Greece, genotype 4 accounts for about 15% of all HCV infections [18][19][20][21][22] and is generally considered as "difficult to treat" in everyday clinical practice.…”

Treatment of Hepatitis C in 2011: What Can We Expect?

“…These agents yield sustained virologic response (SVR) rates of about 40-45% in patients with genotype 1 and 75-80% in patients with genotypes 2 and 3. Patients with genotypes 4, 5, and 6 have SVR rates between these ranges [4,5]. Although the prevalence of the various genotypes varies according to ethnicity, race, and geography [6], the vast majority of patients worldwide are infected with HCV genotype 1 and fail to achieve SVR with the currently available therapy.…”