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Determinants of relapse after a short (12 weeks) course of antiviral therapy and re‐treatment efficacy of a prolonged course in patients with chronic hepatitis C virus genotype 2 or 3 infection
Author(s) -
Mangia Alessandra,
Minerva Nicola,
Bacca Donato,
Cozzolongo Raffaele,
Agostinacchio Ernesto,
Sogari Fernando,
Scotto Gaetano,
Vinelli Francesco,
Ricci Giovanni Luciano,
Romano Mario,
Carretta Vito,
Petruzzellis Daniela,
Andriulli Angelo
Publication year - 2009
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.22679
Subject(s) - short course , medicine , chronic hepatitis , genotype , antiviral therapy , hepatitis c virus , virus , antiviral treatment , oncology , virology , immunology , pediatrics , biology , gene , biochemistry
In hepatitis C virus (HCV) genotypes 2 and 3 patients, the high rate of relapse after 12 to 16 weeks of antiviral therapy is the main concern for shortening treatment duration. This study was undertaken to delineate predictors of relapse after short treatment in patients with undetectable HCV RNA at treatment week 4 (RVR), and to report in RVR patients with relapse the sustained virological response (SVR) after a second 24‐week course of therapy. RVR patients received pegylated interferon (Peg‐IFN) alfa‐2b (1.5 μg/kg) and ribavirin (1000‐1200 mg/day) for 12 weeks; those who relapsed were re‐treated with the same drug doses but for the extended standard duration of 24 weeks. Logistic regression analysis was applied to delineate predictors of relapse by using age, sex, route of transmission, body mass index (BMI), serum alanine aminotransferase (ALT), HCV genotypes, serum HCV RNA levels, and platelet counts as covariates. Of 718 patients with genotypes 2 and 3 who were started on therapy, 496 (69.1%) had undetectable HCV RNA at week 4. Of them, 409 patients (82.5%, CI 79.1‐85.8) attained SVR, and 67 (14.1%, CI 10.4‐16.5) relapsed. At regression analysis, only platelet count less than 140,000 mm 3 [odds ratio, 2.51; confidence interval (CI), 1.49‐4.20] and BMI 30 or higher (odds ratio, 1.7; CI, 1.03‐2.70) were independently associated with relapse. Forty‐three of 67 patients with relapse agreed to be re‐treated, and an SVR was achieved in 30 (70.0%) of them. Conclusion: We recommend 12 weeks course of therapy for patients with undetectable HCV RNA at treatment week 4, providing they present with no advanced fibrosis and low BMI. (H EPATOLOGY 2008.)