PREDICTIVE FACTORS OF SUSTAINED VIRAL RESPONSE IN PATIENTS WITH MILD HEPATITIS C
Speranta Iacob, Liana Gheorghe, M. Grigorescu, I. Sporea, Iulia Simionov, Iuliana Pirvulescu, Roxana Vadan, G. Becheanu
Background: Two-third of hepatitis C virus (HCV) carriers present mild histological lesions at 858g623i liver biopsy. Many experts recommend a "watch and wait" policy in these patients, with periodic observation to identify those with disease progression. Recently was shown that patients with mild liver disease have a significant risk of disease progression at medium- and long-term follow-up and should be considered for antiviral therapy.
Aim and method: To evaluate the rate of sustained viral response (SVR) and the predictive factors of SVR in HCV genotype 1 patients with mild hepatitis C (fibrosis stage 0-1) treated with combination therapy (either pegylated interferon a-2a or a-2b and ribavirin 800-1200 mg/day) for 48 weeks. 260 naïve patients were prospectively followed-up during 72 weeks in 3 referral hepatology centers between June 2004 and June 2006. Univariate and multivariate logistic regression analysis have been conducted.
Results: There were 66.2% women and 33.8% men with a mean age of 46.3±10.5 years. 130 patients received peginterferon a-2a and 130 peginterferon a-2b. The early virological response evaluated at week 12 was 88.1% and the SVR was 74.2%. In the univariate analysis the SVR was associated with young age at beginning of therapy (p=0.001), low (≤400,000 UI/ml) baseline viremia (p=0.03) and high aminotransferases levels (p=0.04) and was not associated with gender, body mass index <27 kg/m2, grade of inflammatory activity, absence of steatosis, ribavirin dose or need to decrease peginterferon or premature cessation of the therapy. Multivariate analysis has identified the following independent predictors of SVR: age <50 years (p=0.0009), baseline viral load <400,000 IU/mL (p=0.03) and aminotransferase level >2 times normal value (p=0.02).
Conclusion: Genotype 1 HCV patients with mild hepatitis have a high rate of SVR, similar to genotype non-1 patients. Young age at diagnosis, low viral load and significant hepatocytolisis are independent predictors of SVR in patients with mild hepatitis. Young patients with mild hepatitis C and low viral load seem to have an easier-to-treat profile and could be candidates for the evaluation of a 6 months combined antiviral regimen.
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