Revisiting the Predictors of a Sustained Virologic Response in the Era of Direct-Acting Antiviral Therapy for Hepatitis C Virus

Several host (age, sex, race, fibrosis stage, interleukin 28B polymorphism) and viral factors (hepatitis C virus [HCV] genotype, viral load) allow estimating the response to interferon-based therapies (which includes first-generation protease inhibitors) before treatment. However, treatment should n...

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Bibliographic Details
Published in:Clinical infectious diseases 2013-01, Vol.56 (1), p.118-122
Main Authors: Beinhardt, Sandra, Rutter, Karoline, Stättermayer, Albert Friedrich, Ferenci, Peter
Format: Article
Language:English
Subjects:
Adult
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antiviral agents
Antiviral Agents - therapeutic use
Antiviral drugs
Antivirals
Biological and medical sciences
Chronic hepatitis
Drug therapy
Female
Gastroenterology
Genotype & phenotype
Genotypes
Hepacivirus
Hepacivirus - drug effects
Hepacivirus - isolation & purification
Hepatitis
Hepatitis C
Hepatitis C - blood
Hepatitis C - drug therapy
Hepatitis C - genetics
Hepatitis C - virology
Hepatitis C virus
Host-Pathogen Interactions
Human viral diseases
Humans
Infections
Infectious diseases
Insulin resistance
Interferon-alpha - therapeutic use
Interferons
Interleukins - genetics
Male
Medical sciences
Pharmacology. Drug treatments
Polyethylene Glycols - therapeutic use
Polymorphism
Recombinant Proteins - therapeutic use
Ribavirin - therapeutic use
RNA, Viral - blood
Sensitivity and Specificity
Treatment Outcome
Viral diseases
VIRAL HEPATITIS
Viral Load
Virology
Viruses
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Description
Summary:Several host (age, sex, race, fibrosis stage, interleukin 28B polymorphism) and viral factors (hepatitis C virus [HCV] genotype, viral load) allow estimating the response to interferon-based therapies (which includes first-generation protease inhibitors) before treatment. However, treatment should not be denied to any patient based on unfavorable factors alone. Metabolic conditions associated with poor response (diabetes, insulin resistance, obesity) and alcohol abuse can be influenced before starting treatment. "On-treatment" predictors of response allow treatment to be tailored to the individual need of the patient. Patients with undetectable HCV RNA after 4 weeks (rapid virologic response [RVR]) have the highest chance for cure (>85%) both by dual and triple therapy. For triple therapy, the decision to shorten treatment requires that the virus remains undetectable for an additional 8 (telaprevir) to 20 (boceprevir) weeks (extended RVR). Based on viral kinetics, an even earlier prediction after 2 weeks of treatment with direct acting antivirals appears feasible.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/cis843