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JAC Advance Access originally published online on November 25, 2003
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Journal of Antimicrobial Chemotherapy (2004) 53, 15-18
© 2004 The British Society for Antimicrobial Chemotherapy

Leading Article

Predicting the therapeutic response in patients with chronic hepatitis C: the role of viral kinetic studies

Peter Ferenci*

Department of Internal Medicine IV, Gastroenterology and Hepatology, University of Vienna, Waehringer Guertel 18–20, A 1090 Vienna, Austria

A substantial proportion of patients infected with hepatitis C virus (HCV) genotype 1 still does not respond to pegylated interferon-alfa/ribavirin (IFN/RBV) therapy. Factors which identify potential non-responders are needed to limit exposure to drugs in patients unlikely to benefit from treatment and to save health care resources. Host predictive factors have a low negative predictive value. In contrast, viral factors have a high precision in predicting outcome of therapy. Viral kinetics are the basis for the study of response of therapy. The decrease in viral load within 24 h after administration of a single test dose of conventional IFN reflects the IFN-sensitivity of the virus strain and predicts the outcome of conventional IFN/RBV therapy even before treatment with a specificity of 100% and a sensitivity of 83%. In contrast to conventional IFN, the two available PEG-IFN preparations differ considerably in how they suppress viral replication, and cut-off values have to be prospectively established separately for each drug. Patients without an early virological response (HCV-RNA either undetectable or decrease by >=2 log10 after 12 weeks) (EVR), do not achieve a sustained virological response (SVR; negative predictive value: 97–98%). Thus, in the absence of an EVR, treatment should be stopped. The outcome of PEG-IFN alfa-2a/RBV combination therapy is dependent on the rapidity of the virological response. Patients who become HCV-RNA negative after 4 weeks have the best chance of achieving an SVR. The rapidity of viral elimination may be a useful guide to tailoring the length of treatment in patients with an EVR.

Keywords: HCV, therapy, outcome prediction

* Tel: +43-1-40400-4741; Fax: +43-1-40400-4735; E-mail: peter.ferenci{at}akh-wien.ac.at


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M Diago, G Castellano, J Garcia-Samaniego, C Perez, I Fernandez, M Romero, O L Iacono, and C Garcia-Monzon
Association of pretreatment serum interferon {gamma} inducible protein 10 levels with sustained virological response to peginterferon plus ribavirin therapy in genotype 1 infected patients with chronic hepatitis C
Gut, March 1, 2006; 55(3): 374 - 379.
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