Genotype 3 Chronic Hepatitis C Patients Do Not Respond as Well to Interferon-based
age is associated with a lower likelihood of sustained response to pegylated
interferon plus ribavirin in genotype 3 chronic hepatitis C patients, and
people 50 years or older may benefit from longer treatment, according to a study
presented at the recent Digestive Disease Week annual meeting
(DDW 2009) in Chicago.
C virus (HCV) genotypes 2 and 3 are considered easier to treat than genotypes
1 or 4. Current guidelines recommend that patients with genotypes 2 or 3 should
be treated with pegylated interferon
(Pegasys or PegIntron) plus ribavirin for 24 weeks, while those with genotype
1 (and possibly 4) should receive 48 weeks of therapy and higher weight-adjusted
doses of ribavirin.
as Xinyu Zhao and colleagues noted as background, some recent data suggest that
the non-response rate for genotype 2 or 3 patients may be increasing -- reaching
up to 20% -- and little is known about the factors associated with treatment failure.
investigators conducted a retrospective chart review of medical records from 84
individuals (half men, half women) with HCV genotype 3 who were treated with pegylated
interferon plus ribavirin between 2005 and 2007.
participants' average age was 43 years and mean body weight was 80 kg. At baseline,
the mean HCV RNA level was 5.8 log IU/mL and the mean alanine aminotransferase
(ALT) level was 114.6 IU/dL. Patients were excluded if they were previously treatment-experienced,
did not achieve good adherence, or were lost to follow-up.
viral load and ALT were measured after 12 weeks (early virological response) and
24 weeks (end-of-treatment response) of therapy; HCV RNA was checked again 6 months
after completion of treatment to determine sustained
virological response (SVR).
Overall, 54 patients (64.3%) achieved SVR, while 30 were non-responders or relapsers.
In a univariate analysis, age was found to be negatively associated with treatment
response (odds ratio 0.78; P = 0.002).
Sex, body weight, baseline ALT, and baseline HCV RNA were not significantly associated
with SVR, in contrast to some prior studies.
In a multivariate analysis adjusting for sex, body weight, and baseline ALT, age
remained a significant predictor of poor treatment response (OR 0.64; P = 0.01).
on these findings, the researchers concluded, "Therapy response to interferon-based
regimen in patients with HCV genotype 3 infection is negatively affected by increasing
age, suggesting that elderly patients (> 50 years old) with genotype 3 infection
may need longer duration of therapy."
Maimonides Medical Center, Brooklyn, NY; Gastroenterology and Hepatology, Coney
Island Hospital, Brooklyn, NY.
Zhao, MD Bernstein, K Iswara1, and others. Treatment Response Is Negatively Associated
with Age in Genotype 3 Hepatitis C Virus Infection. Digestive Disease Week (DDW
2009). Chicago. May 30-June 4, 2009. Abstract M1802.