https://www.journal-of-hepatology.eu/article/S0168-8278(08)00485-6/pdf

Treatment predictors of a sustained virologic response in hepatitis B and C

https://www.gastrojournal.org/article/S0016-5085(10)01051-6/pdf

A Sustained Virologic Response Is Durable in Patients With Chronic Hepatitis C Treated With Peginterferon Alfa-2a and Ribavirin

Sustained virologic response (SVR) is defined as aviremia 24 weeks after completion of antiviral therapy for chronichepatitisCvirus(HCV)infection.InanalysesofSVRdurability,theincidenceoflaterelapseisextremely low (,1%). Histologic regression of both necroinflammation and fibrosis has been demonstrated in paired liver biopsy samples in SVR-achieving patients. More noteworthy is the sustained responder’s favorable prognosis even with baseline cirrhosis; despite mostly retrospective analyses, relative to nonresponders or to those untreated, patients with SVR have significantly fewer liver-related complications, less hepatocellular carcinoma, and fewer liver-related deaths. Although HCV is associated with insulin resistance, successful eradication of HCV appears to reduce the risk of impaired fasting glucose and diabetes development. In summary, chronic HCV infection is curable with SVR attainment, and with cure comes improved liver histology and more favorable clinical outcomes, in comparison with patients who do not achieve the same therapeutic milestone.

/pdf/sustained-virologic-response-to-antiviral-therapy-for-52t51mvdow.pdf

Sustained Virologic Response to Antiviral Therapy for Chronic Hepatitis C Virus Infection: A Cure and So Much More

Infection with the hepatitis C virus (HCV) is a significant public health concern associated with a high burden of morbidity and mortality [1, 2]. Recent estimates suggest that worldwide, of the 185 million individuals infected, over 700 000 people die annually as a result of infection [3, 4].

The attainment of a sustained virological response (SVR), defined as aviremia 12 or 24 weeks after the completion of antiviral therapy (SVR12 or SVR24), is associated with an improved prognosis compared with patients either untreated or failing therapy. These benefits include improved histology, reduced risk of hepatocellular carcinoma, and improved overall survival [5, 6].

Despite these benefits, treatment uptake for chronic HCV has been low due to complexities of treatment and poor success rates. The availability of new highly efficacious regimens provides the foundation for marked treatment scale-up; however, high costs are currently limiting access [7–10].

One challenge to treatment scale-up is the risk of HCV recurrence, either as late relapse post-SVR or reinfection following treatment. HCV recurrence is a particular concern in patients with ongoing high-risk behaviors, such as injecting drug users (IDUs), who are more susceptible to reinfection, and also patients coinfected with human immunodeficiency virus (HIV) who may be at increased risk of relapse due to their immunocompromised status [11–15].

A number of studies have been carried out to examine the durability of treatment-induced SVR in patients with chronic HCV in a variety of patient populations. Our aim was to systematically review the existing evidence and undertake meta-analysis to provide summary estimates of the recurrence rate by risk group. The secondary aim was to evaluate the contribution of late relapse and of reinfection to the recurrence rate. This work fits within the theme one of the PROGRESS framework for prognosis research (“fundamental prognosis research”) and will provide a clearer understanding of HCV recurrence to inform the provision of antiviral therapy [16].

/pdf/risk-of-late-relapse-or-reinfection-with-hepatitis-c-virus-tvdpr4c5dc.pdf

Risk of Late Relapse or Reinfection With Hepatitis C Virus After Achieving a Sustained Virological Response: A Systematic Review and Meta-analysis

Occult hepatitis C: How convincing are the current data?†

Summary


Background Combination anti-viral therapy achieves a sustained virological response (defined as HCV-RNA negativity 6 months after the end of therapy) of 56% of patients with chronic hepatitis C. Little is known about long-term durability of HCV-RNA negativity in patient treated with pegylated interferon.



Aim To evaluate the durability of virologic response in patients with sustained virological response to anti-viral therapy treated at our centre.



Methods  A total of 187 sustained virological responses (50% genotype 1, 42% genotype 2 or 3 and 8% genotype 4; 20% with cirrhosis) with a follow-up of >12 months post-therapy were studied. Twelve patients received monotherapy with interferon-alpha2a or −2b. One hundred and seventy-five received combination therapy with ribavirin and standard interferon-alpha (n = 73) or pegylated interferon-alpha2a or 2b (n = 102). Qualitative serum HCV-RNA was tested by COBAS AMPLICOR HCV test, v2.0.



Results  Median follow-up time was 29 months (range 12–172). Recurrence of HCV infection was not observed in any of the 187 sustained virological responders. Alanine aminotransferase values were normal in 90% and two patients showed minimal elevation of alpha-fetoprotein levels.



Conclusions  No recurrence of HCV infection was seen in any patient. Thus, long-term prognosis in chronic hepatitis C patients with a sustained virological response to therapy with pegylated interferon ± ribavirin is promising, but long-term studies need to continue.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-2036.2006.02785.x

E. Formann

Papers

Long-term follow-up of chronic hepatitis C patients with sustained virological response to various forms of interferon-based anti-viral therapy