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Chronic hepatitis C: treatment of pegylated interferon/ribavirin nonresponders
1Hepatology Section, Virginia Commonwealth University Medical Center, Box 980341, Richmond, VA 23298, USA. mshiffma@hsc.vcu.edu
Insights
Chronic hepatitis C virus (HCV) nonresponders require careful evaluation. Some patients may benefit from retreatment, while others with mild disease should be monitored for future therapies.
Area of Science:
- Hepatology
- Virology
- Internal Medicine
Background:
- A growing population of patients with chronic hepatitis C virus (HCV) are nonresponders to pegylated interferon and ribavirin therapy.
- These patients often have genotype 1, high viral load, advanced fibrosis or cirrhosis, and are frequently of African-American race.
Purpose of the Study:
- To evaluate chronic hepatitis C virus (HCV) nonresponders.
- To characterize previous nonresponse and identify correctable factors for potential retreatment.
- To determine appropriate management strategies for different patient subgroups.
Main Methods:
- Thorough review of previous treatment records.
- Characterization of the type of nonresponse (null response, partial response, breakthrough, relapse).
- Assessment of fibrosis and cirrhosis.
Main Results:
- Patients with prior null response are likely interferon-resistant.
- Patients with partial response, breakthrough, or relapse may achieve sustained virologic response with addressed correctable factors.
- HCV nonresponders with no or mild fibrosis have an excellent prognosis and low risk of cirrhosis.
Conclusions:
- Management of chronic hepatitis C virus (HCV) nonresponders should be individualized based on prior treatment response and disease severity.
- Retreatment may be beneficial for select patients with identifiable correctable factors.
- Monitoring is recommended for patients with mild fibrosis pending development of more effective therapies.
Abstract:
Patients with chronic hepatitis C virus (HCV) who were nonresponders to previous treatment with pegylated interferon and ribavirin are a growing population. The vast majority have genotype 1, a high viral load, advanced fibrosis or cirrhosis, and are of African-American race. The evaluation of these patients should include a thorough review of the previous treatment record and characterization of the previous nonresponse. Patients with prior null response are likely resistant to the effects of interferon. In contrast, patients with partial virologic response, breakthrough, and relapse could potentially achieve sustained virologic response if one or more correctable factors that contributed to the prior nonresponse are identified and addressed before and during retreatment. Many HCV nonresponders, especially those with no fibrosis or mild fibrosis, have an excellent prognosis, are at low risk to develop cirrhosis, and should simply be monitored at periodic intervals until more effective therapy has been developed.
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