Sustained Virological Response Rates to Antiviral Therapy in Genotype 1 and 3 Chronic Hepatitis C Patients: A Study from North India

Abstract

Background: In India, both genotype 3 and 1 are predominant genotypes in patients with chronic hepatitis C (CHC). However, there is scanty data on sustained viral response (SVR) rate with conventionally recommended dual therapy with PEG-IFN and ribavirin. Methods: In this retrospective study, consecutive patients of CHC of genotypes 1 and 3, attending the single unit of Gastroenterology of our hospital, who received PEG-IFN and ribavirin therapy, were included. Patients who had co-infection with HIV or HBV were excluded. Results: A total of 114 patients were included in the study median age 44 (15-72) years, 79% males. Most common presentation was with chronic hepatitis, while 10 (9%) patients had compensated cirrhosis. Nine (8%) patients had associated diabetes, 16 (14%) patients gave history of significant alcohol abuse. The median baseline HCV RNA level was 3.0 Â 10 5 (1.7 Â 10 3 -1.8 Â 10 7 ) IU/mL. The most common genotype was 3 (75%) followed by genotype 1 (25%). 70% patients received PegIFN-a2a (median dose 180 MIU/wk) and 30% patients received PegIFN-a2b (median dose 80 MIU/wk). The median ribavirin dose was 800 (range 800-1200) mg. SVR in genotype 1 was 64% (18/28) while SVR in genotype 3 was 73% (63/86). The factors predicting SVR on univariate analysis were a lower baseline HCV RNA level (less than 3.0 Â 10 5 ), higher hemoglobin level > 11.8 g/dl, and achievement of rapid virological response (RVR), early virological response (EVR) and end of treatment response (ETR). In multivariate analysis the only baseline factor found independently correlating with SVR was low HCV RNA level (<3.0 Â 10 5 IU/mL) (P = 0.003). Conclusion: In north India, HCV genotype 3 has a SVR rate of 73%, which is comparable to genotype 1 with SVR rate of 64% when treated with PEG-IFN and ribavirin therapy. A baseline HCV RNA level lower than 3.0 Â 10 5 best predicts SVR in addition to achievement of RVR, EVR or ETR. ( J CLIN EXP HEPATOL 2014;4:287-292)

Parallel expression profiling of hepatic and serum microRNA-122 associated with clinical features and treatment responses in chronic hepatitis C patients

“…On the other hand, ALT levels were not significantly associated with SVR. This is in agreement to previous studies which also demonstrated lack of prognostic value of ALT levels with ETR in CHC patients of genotype 3 and 1 45 46 .…”

End Treatment Response and Sustained Viral Response in Patients With Hepatitis C Virus Receiving Sofosbuvir and Daclatasvir

“…As per the American Association for the Study of Liver Diseases guidelines PCR-positive patients at the end of treatment and three months after the completion of treatment were stated as non-responders [13]. Patients who were negative by PCR at the end of treatment at 12 weeks but were found to be positive by PCR at three months after the end of treatment were labeled as relapsed.…”

Newer direct-acting antivirals for hepatitis C virus infection

“…The most prevalent HCV genotype in India is genotype 3, and the standard therapy for this genotype till now had been a combination of PEG-IFN and RBV for 24 wk, with an SVR rate of 70 per cent or more 7 . The SVR rate for those infected with genotype 1 (the second most common HCV genotype in India) was 40-60 per cent, with a treatment duration of 48 wk 12 13 14 . Traditionally, HCV-genotypes 2 and 3 were considered to be easy to treat and 1 and 4 were considered to be difficult to treat with conventional PEG-IFN–RBV therapy 12 .…”

“…Undetectable HCV RNA at week four of therapy, also known as the rapid virologic response (RVR), is one of the strongest predictors of SVR 14 39 . Thus, a shorter duration of treatment of 24 wk of PEG-IFN plus RBV dual therapy can be given to patients who do not achieve an RVR 40 .…”