IL28B polymorphism -- predictive factor of HCV infected genotype 1 individuals to treatment response and management of therapy

It is estimated that approximately 3% of the world population are chronically infected with HCV, as the annual incidence of HCV infection is approximately 3-4 million people. Despite all efforts made to eradicate the HCV infection, after the standard therapy (PegIFN and ribavirin for 48 weeks) only 40-50% of the HCV infected individuals with genotype 1 achieve sustained virological response (SVR). Since our goal today is the eradication of HCV infection, our prior concern has become the identification of predictor factors concerning treatment response. Recent studies such as GWAS have been concerned with the genetic factors and the response to treatment. Recently all interest has been turned towards the demonstration of the host polymorphism located upstream of the IL-28B gene and which is associated with sustained virological response to treatment with pegylated interferon Alfa in combination with ribavirin. Although 2011 comes with the FDA approval of the new triple therapy associating telaprevir/ boceprevir to the standard therapy, a new ethical concern regarding the high costs of this treatment rises the problem of who is the first in line? This is just the beginning of a new quest to further investigate the relationship between the host's polymorphism of the IL-28 gene and the standard and triple therapy in HCV infected individuals in achieving SVR as well as who should receive standard or triple therapy. Determination of the IL-28 polymorphisms may be used together with clinical assessment in order to evaluate patients and to personalize their treatment. The purpose of this paper is to underline the main concerns regarding the goal and endpoints of the HCV therapy, and the relationship of IL-28 in achieving sustained virological response, as well as in pointing out the importance to determine prior to initiating treatment the polymorphism of IL-28 since it is a strong predictor. This is important because it will increase the chances to achieve SVR, it will be cost-effective and reduces adverse effects.