The results of antiviral therapy in patients with chronic C-hepatitis

Authors: Vadim Brjalin   Riina Salupere   Tatjana Tallo   Ljudmilla Priimägi   Valentina Tefanova  

AIM. To evaluate the efficacy of combined antiviral therapy in Estonian patients with chronic hepatitis C virus (HCV) infection.

METHODS. From February 2005 to October 2008, a total of 83 treatment-naïve patients (51 male and 32 female, age range 19 to 63 years, mean age 39.9) with chronic HCV infection were enrolled in the study and treated on an outpatient basis with a standard regimen of PegIFNα-2a plus Ribavirin according to the virus genotype (G): for G1 the treatment lasted 48 weeks and for G2 and G3, 24 weeks. There were 55 patients with G1 infection and 28 patients with G2 or G3 infection. The baseline viral load ranged from 13 900 IU/ml to 11 900 000 IU/ml. Histologically, 64 (77.1%) patients had a fibrosis score of 0–1. Four patients, all with G1 infection, had a fibrosis score of 4 (cirrhosis).

RESULTS. Sustained virological response (SVR) in this setting was achieved in 48 patients (57.8%). Among the pat ients infected with G2 and G3, 24 (85.7%) attained SVR, while among the patients with G1, SVR was achieved in 24 (43.6%) (P < 0.001). Altogether, 70% of the patients  with a viral load of < 600 000 IU/ml attained SVR. The SVR level was higher in patients with G2 and G3 than in those with G1, but there was no signifi cant difference between these groups. Forty patients (62.5%) with a fibrosis score of 0–1 attained SVR; in the group with fibrosis scores of 2 and 3 only 8 patients (53.3%) showed SVR; all patients with cirrhosis failed to attain SVR. The level of SVR was signifi cantly (P< 0.05) higher in patients under 40 years of age than in older patients. The most prevalent side effects of interferon plus ribavirin therapy included fatigue, and haematologic abnormalities such as anaemia, and leuko-, neutro- and thrombocytopenia.

CONCLUSIONS. It was shown that such viral factors as HCV genotype and baseline viral load, and such host factors as score of fibrosis and age predetermined the results of combined therapy with pegylated interferon-alpha and ribavirin in Estonian patients with chronic HCV infection. Special attention should be paid to patients with G1, because of worse baseline parameters and low rate of sustained virologic response, compared with other genotypes, as well as to the high percentage of nonresponders and relapsers.

Eesti Arst 2010; 89(3):172−178