Early Response Does Not Predict Sustained Response Among African American Patients

Past research has established that people of African descent, especially those with genotype 1 HCV, respond less well to treatment for hepatitis C compared with Caucasian patients.

A study presented at the Digestive Disease Week conference in Los Angeles in May found that early virological response (EVR) may be a poor predictor of sustained virological response (SVR) in this population.

In this study, 59 African American patients with genotype 1 HCV received treatment with pegylated interferon plus ribavirin during a three-year period at a community hepatology clinic. About half were men, the mean age was 50 years, mean body weight was 204 pounds, and baseline HCV viral load was 6.07 log IU/mL.

Results

After 12 weeks of therapy, 33 out of 59 patients (56%) achieved EVR (undetectable HCV RNA), three were lost to follow-up, and two were non-compliant. Only three out of 50 patients (6%) achieved SVR 24 weeks after completion of therapy; 12 relapsed after achieving EVR (66%), six were lost to follow-up, three withdrew due to adverse events (two with anemia, one with depression), and nine were still undergoing treatment. Patients who achieved undetectable HCV RNA at week 12 had lower baseline HCV RNA (5.67 log IU/mL vs 6.19 log IU/mL; P < 0.01) and lower inflammation scores on liver biopsy (4.07 vs 5.55; P < 0.01) than those who did not achieve EVR. EVR had a positive predictive value of just 11% (three out of 33) for SVR.

Conclusion

The researchers concluded, based on this study, that African American patients treated in a community setting may have an EVR rate comparable to that seen in published studies, but a much lower SVR rate. Thus, they suggested that, "EVR is not a good predictor for SVR in this patient population." In addition, low baseline HCV RNA and minimal hepatocyte inflammation appeared to be associated with better treatment response.

6/13/06

Reference
X. Zhao, J. Izanec, R. Rivera, and others. EVR is a poor predictor of SVR is African Americans with genotype 1 Hepatitis C infection: a community clinic experience. Abstract T1833. Digestive Disease Week 2006. May 20-25, 2006. Los Angeles, CA.