The meaning of viral kinetics in the beginning of the pegylated interferon-alpha and ribavirin therapy for chronic hepatitis C

Česká verzia

Authors: P. Husa ¹; P. Šlesinger ¹; H. Štroblová ²; A. Svobodník ³
Authors place of work: Klinika infekčních chorob Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Petr Husa, CSc. ¹; Oddělení klinické mikrobiologie FN Brno, pracoviště Bohunice, přednostka prim. MUDr. Alena Ševčíková ²; Centrum biostatistiky a analýz MU Brno, vedoucí doc. RNDr. Ladislav Dušek, Ph. D. ³
Published in the journal: Vnitř Lék 2006; 52(2): 153-159
Category: Original Contributions

Summary

Pegylated interferon α (PEG-IFN) and ribavirin combination therapy is the contemporary standard therapy of the patients chronically infected with hepatitis C virus (HCV).

Objective of the study:
The study is monitoring the changes in viremy through the changes of HCV RNA in serum before and during antiviral therapy and it attempts to find a relationship between the viral kinetics in the beginning of the therapy and the sustained virologic response.

Set of the patients and the methodics:
The study involved 133 patients with chronic infection with HCV, of the average age of 38 years (ranged 18–68 years). 86 of them were men. There were 88 patients who had not been treated before (naive patients), 19 of them were relabing and 26 were non-responders to the previous therapy with conventional IFNα and ribavirin. 106 patients (80 %) were infected with genotype (G) 1, 3 (2 %) with G2, 18 (14 %) with G3, 1 patient with G4 and 1 with G6 (under 1 %), in 4 (3 %) the genotype could not be determined. All of them were treated with the combination of PEG-IFNα-2a (180 μg once a week) and ribavirin (800 mg per day in the infection with G2 or G3, 1 000 mg at the infection with G1 and the weight up to 74 kg, 1 200 mg per day at the infection with G1 and the weight 75 kg and higher).

Results:
Up to now, 122 patients completed the therapy and 93 of them (76 %) had negative HCV RNA in serum at the time of completion of the therapy. Negative HCV RNA after 24 weeks (sustained virologic response † SVR) after the completion of the therapy had 64/107 (60 %) of the treated patients. In the course of 12 weeks of the therapy the viremy decreased by at least 2 decadic logarithms (early virologic response – EVR) in 87 patients (82 %) and in 63 of them (72 %) also SVR was noted. Only 19 patients had not EVR and just 1 one of them, nevertheless, achieved SVR (5 %).

Conclusion:
The achievement of EVR is a prerequisite to the successful therapy for chronic infection with HCV with the combination of PEG-IFNα and ribavirin. Quantitative determination of HCV RNA in serum before and during antiviral therapy is a prerequisite to the modern antiviral therapy for chronic infection with HCV.

Key words:
chronic hepatitis C – viral kinetics – pegylated interferon – ribavirin – sustained viral response

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