http://evolve.zoo.ox.ac.uk/Evolve/Oliver_Pybus_files/GlobalDistOfHCVGenotypes.pdf

Global Distribution and Prevalence of Hepatitis C Virus Genotypes

background We hypothesized that in patients with hepatitis C virus (HCV) genotype 2 or 3 in whom HCV RNA is not detectable after 4 weeks of therapy, 12 weeks of treatment is as effective as 24 weeks. methods A total of 283 patients were randomly assigned to a standard 24-week regimen of peginterferon alfa-2b at a dose of 1.0 µg per kilogram weekly plus ribavirin at a dose of 1000 mg or 1200 mg daily, on the basis of body weight. Of these, 70 patients were assigned to the 24-week regimen (standard-duration group) and 213 patients to a variable regimen (variable-duration group) of 12 or 24 weeks, depending on whether tests for HCV RNA were negative or positive at week 4. The primary end point was HCV that was not detectable by polymerase-chain-reaction (PCR) assay 24 weeks after the completion of therapy. results In the standard-duration group, 45 (64 percent) patients had HCV that was not detectable by PCR assay at week 4, as compared with 133 (62 percent) in the variable-duration group (difference [the rate in the standard-duration group minus that in the variableduration group], 2 percent; 95 percent confidence interval, i11 to 15 percent). Fiftythree patients (76 percent) in the standard-duration group and 164 patients (77 percent) in the variable-duration group had a sustained virologic response (difference, i1 percent; 95 percent confidence interval, i13 to 10 percent). Fewer patients in the variableduration group receiving the 12-week regimen had adverse events and withdrew than in the group receiving the 24-week regimen (P=0.045). The rate of relapse (defined as HCV not detectable at the end of treatment but detectable at the end of follow-up) was 3.6 percent in the standard-duration group and 8.9 percent in the variable-duration group (P=0.16). Overall, the rate of sustained virologic response was 80 percent among patients with HCV genotype 2 and 66 percent among those with genotype 3 (P<0.001). conclusions A shorter course of therapy over 12 weeks with peginterferon alfa-2b and ribavirin is as effective as a 24-week course for patients with HCV genotype 2 or 3 who have a response to treatment at 4 weeks.

/pdf/peginterferon-alfa-2b-and-ribavirin-for-12-vs-24-weeks-in-2f5ja4r18o.pdf

Peginterferon alfa-2b and ribavirin for 12 vs. 24 weeks in HCV genotype 2 or 3.

Chronic hepatitis C (HCV) infection is currently oneof the most clinically relevant comorbidities in theHIV population; overall, it affects one third of HIV-positive individuals [1]. Progression to end-stage liverdisease occurs faster in coinfected patients [2–4] anddecompensated cirrhosis is one of the main causes ofhospitalization and death in this population [5–8].However, the risk of hepatotoxicity using antiretroviraldrugs is increased in subjects with underlying HCVinfection [9,10]. Therefore, the optimal managementof chronic HCV in HIV-positive patients is currentlyapriority.Several guidelines for caring for HCV infection in HIV-positive individuals have been released [11–15]. Becausenew and relevant information has recently appeared, it isconvenient to update them. Eleven areas have beenidentiﬁed in which new recommendations are particu-larly needed:management of patients with persistently normalaminotransferasesliver ﬁbrosis assessment: when and howpredictors of response to anti-HCV therapy in coinfectedpatientsoptimal dosages of pegylated interferon (pegIFN) andribavirin (RBV)optimal duration of anti-HCV therapytreatment of non-responders and/or relapserscare of patients with end-stage liver diseasetreatment of acute HCV infection in HIV-infectedindividualsmanagement of patients with multiple hepatitis virusesinteractions between HCV medications and antiretroviraldrugshepatotoxicity of antiretroviral drugs.

/pdf/care-of-patients-coinfected-with-hiv-and-hepatitis-c-virus-4rfadwqaui.pdf

Care of patients coinfected with HIV and hepatitis C virus: 2007 updated recommendations from the HCV-HIV International Panel.

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

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

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

Tongue and Skin Hyperpigmentation During PEG-Interferon-|[alpha]|/Ribavirin Therapy in Dark-Skinned Non-Caucasian Patients with Chronic Hepatitis C

https://www.journal-of-hepatology.eu/article/S0168-8278(06)80010-3/pdf

8 24 Week treatment regimen with peginterferon alpha-2a (40KD) (PEGASYS®) plus ribavirin (COPEGUS®) in HCV genotype 1 or 4 ‘super-responders’

82 Further reduction of ribavirin dose in HCV genotype 2/3 patients receiving peginterferon alpha-2a (40KD) (PEGASYS®) plus ribavirin (COPEGUS®): Interim results of a randomised controlled trial

BACKGROUND AND AIM: Patients with advanced liver disease due to thrombocytopenia and chronic infection with hepatitis C virus (HCV) are difficult to treat in view of concerns about the efficacy and safety of interferon-based therapy. Nevertheless, antiviral therapy might have a substantial benefit in these patients as it potentially minimizes disease progression and prevents recurrence after liver transplantation. We evaluated the safety, efficacy and tolerability of standard interferon-alpha in an accelerating dose regimen in combination with ribavirin in patients with HCV-induced liver cirrhosis and thrombocytopenia. PATIENTS: Nine patients (M = 8, age: 48.4 ± 9.9, mean ± SD) with HCV-related advanced liver disease and thrombocytopenia were prospectively investigated. The Child–Pugh stage was A in six patients and B in three, the MELD score was 11 [6–17] (median [range]). Four patients were interferon naive. HCV-genotype distribution was 1b (n = 3), 3a (n = 4) and 4 (n = 2). The patients received 1–1.5 MU/d standard interferon-a2b with increasing dose regimen and weight-based ribavirin for 48 weeks (genotype 1), or 24 weeks (genotype 3), or until liver transplantation, respectively. RESULTS: The baseline platelet count was 64.3 ± 8.7 (G/l, mean ± SD) and remained remarkably stable during treatment (58.0 ± 12.4 G/l at week 4, 51.7 ± 20.5 G/l at week 8, P = 0.1). All patients had adverse events such as weight loss, fever and anorexia. Hospitalization because of decompensation or infection was necessary in three patients. Three patients underwent liver transplantation. A virological response on treatment was achieved in eight patients and sustained in three (33.3%) patients. CONCLUSION: Treatment with standard interferon-alpha2b/ribavirin could be of benefit in patients with advanced liver cirrhosis and thrombocytopenia however, a vigilant monitoring of these high risk patients is mandatory.

U. Bergholz

Papers

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

Tongue and Skin Hyperpigmentation During PEG-Interferon-|[alpha]|/Ribavirin Therapy in Dark-Skinned Non-Caucasian Patients with Chronic Hepatitis C

8 24 Week treatment regimen with peginterferon alpha-2a (40KD) (PEGASYS®) plus ribavirin (COPEGUS®) in HCV genotype 1 or 4 ‘super-responders’

82 Further reduction of ribavirin dose in HCV genotype 2/3 patients receiving peginterferon alpha-2a (40KD) (PEGASYS®) plus ribavirin (COPEGUS®): Interim results of a randomised controlled trial

Standard interferon-alpha in combination with ribavirin for hepatitis C patients with advanced liver disease and thrombocytopenia