Viral kinetics during the first weeks of pegylated interferon and ribavirin treatment can identify patients at risk of relapse after its discontinuation: new strategies for such patients?

Predictors of Pegylated Interferon Alpha and Ribavirin Efficacy and Long-Term Assessment of Relapse in Patients With Chronic Hepatitis C: A One-Center Experience From China

BACKGROUND

Sustained virological response (SVR) and virological relapse maintain pivotal roles in the management of chronic hepatitis C (CHC); however, there is little data regarding the long-term outcomes of patients with CHC in China.

OBJECTIVES

We aimed to investigate the predictive factors of therapeutic effect and viral relapse in patients who achieved end-of-treatment response (ETR).

PATIENTS AND METHODS

We retrospectively analyzed clinical, biochemical and virological data of 169 adult patients with CHC from China who were not treated with pegylated interferon-alpha (PEG IFN-α) and ribavirin, of which 142 achieved ETR and with a follow-up period ranging from six months to six years. Statistical analysis was performed by SPSS 20.0.

RESULTS

Of the 169 patients, 124 (73.4%) achieved SVR and 23 (16.2%) experienced relapses post-therapy in cases of ETR patients. We considered sex, age, alanine aminotransferase, aspartate transaminase, baseline hepatitis C virus RNA level, HCV genotypes, IL28B rs12979860 genotype, rapid virological response (RVR), and early virological response (EVR). For antiviral effect in patients with CHC, HCV genotypes (2, 3) (χ(2) = 11.285, P = 0.001), IL28B genotype (rs12979860 CC) (χ(2) = 16.552, P < 0.001), RVR (χ(2) = 37.339, P < 0.001), and EVR (χ(2) = 70.265, P < 0.001) were significantly correlated with achieving SVR. For ETR patients with long-term follow-up, the relapse rate within six months was significantly higher than within other periods during six-year follow-up (χ(2) = 7.792, P = 0.005). Relapse was virtually not observed after therapy ceased for 48 weeks. The IL28B genotype (rs12979860 CT/TT) (OR = 0.102; 95% CI, 0.031-0.339; P < 0.001), lower RVR (OR = 0.239; 95% CI, 0.078-0.738; P = 0.013), and EVR (OR = 0.102; 95% CI, 0.016-0.661; P = 0.017) were independent risk factors for relapse.

CONCLUSIONS

Our study comprehensively explored the predictive factors of therapeutic effect of administered drugs and analyzed viral relapse during a six-months to six-year follow-up period from China. The SVR may not be the perfect endpoint of HCV therapy in Chinese people; we recommend 48 weeks after treatment withdrawal as the suitable time point.

Curative effects of peg-interferon α-2a plus ribavirin and ursodeoxycholic acid in chronic hepatitis C patients

AIM: To explore the curative effects of peg-interferon α-2a plus ribavirin and ursodeoxycholic acid (UDCA) in chronic hepatitis C (CHC) patients.

METHODS: Eighty-four patients with HCV were randomly divided into two groups: an experimental group and a control group. The experiment group was treated by peg-interferon α-2a plus ribavirin and UDCA, and the control group was treated by peg-interferon α-2a plus ribavirin. The response rates in patients with HCV genotype 1 or other genotypes, the improvement of liver function during therapy, autoimmune conditions and interferon side effects were compared.

RESULTS: There was no statistically significant difference between the two groups in the response rates in patients with HCV genotype 1 (9.52% vs 9.52%, 64.29% vs 61.90%, 54.76% vs 54.76%, P > 0.05) or non-genotype 1 (14.29% vs 16.67%, 76.19% vs 73.81%, 76.19% vs 73.81%, P > 0.05). The rates of improvement of ALT at weeks 48 and 72 (80.95% vs 71.43%, 83.33% vs 73.81%, P < 0.05), AST (80.95% vs 64.29%, 85.71% vs 69.05%, 83.33% vs 73.81%, P < 0.05) and GGT at weeks 24, 48 and 72 (85.71% vs 76.19%, 100.00% vs 90.48%, 92.86% vs 80.95%, P < 0.05), and TBIL at weeks 4, 12, 24, 48 and 72 (59.52% vs 47.62%, 76.19% vs 59.52%, 92.86% vs 80.95%, 97.62% vs 83.33%, 92.86% vs 80.95%) were significantly better in the experimental group than in the control group. The positive rate of autoimmune antibody was significantly lower in the experimental group than in the control group (16.67% vs 33.33%, P < 0.05). There were no statistically significant differences in the incidence of hypothyroidism (2.38% vs 4.76%), diabetes (0.00% vs 2.38%), weakness (47.62% vs 47.62%), sore muscle (45.24% vs 47.62%), fever (26.19% vs 28.57%), myelosuppression (23.81% vs 30.95%), or thyroid abnormality (7.14% vs 11.90%).

CONCLUSION: Peg-interferon α-2a plus ribavirin and UDCA can improve the liver function and reduce the side effects of interferon and the occurrence of autoimmune disorder in chronic hepatitis C patients.

Differences in HCV viral decline between low and standard-dose pegylated-interferon-alpha-2a with ribavirin in HIV/HCV genotype 3 patients

Background

The aim of the study was to analyze the different impact of standard and low-dose Peg-IFN-α2a/RBV therapies on HCV viral decline in HIV/HCV genotype 3 co-infected patients during the first weeks of treatment.

Methods

Plasma HCV viral decline was analyzed between baseline and weeks 1, 2 and 4 in two groups of treatment-naïve HCV genotype 3 patients with HIV co-infection. The Standard Dose Group (SDG) included patients who received Peg-IFN at 180 µg/per week with a weight-adjusted dose of ribavirin; Low-Dose Group (LDG) patients received Peg-IFN at 135 µg/per week with 800 mg/day ribavirin. The effect of IL28B genotype on HCV viral decline was evaluated in both groups. HCV viral decline was analyzed using a multivariate linear regression model.

Results

One hundred and six patients were included: 48 patients in the SDG and 58 in the LDG. HCV viral decline for patients in the LDG was less than for those in the SDG (week 1∶1.72±0.74 log₁₀ IU/mL versus 1.78±0.67 log₁₀ IU/mL, p = 0.827; week 2∶2.3±0.89 log₁₀ IU/mL versus 3.01±1.02 log₁₀ IU/mL, p = 0.013; week 4∶3.52±1.2 log₁₀ IU/mL versus 4.09±1.1 log₁₀ IU/mL, p = 0.005). The linear regression model identified the Peg-IFN/RBV dose as an independent factor for HCV viral decline at week 4.

Conclusions

Our results showed that HCV viral decline was less for patients in the low-dose group compared to those receiving the standard dose. Until a randomized clinical trial is conducted, clinicians should be cautious about using lower doses of Peg-IFN/RBV in HIV/HCV genotype 3 co-infected patients.

Viral quasispecies evolution

Evolution of RNA viruses occurs through disequilibria of collections of closely related mutant spectra or mutant clouds termed viral quasispecies. Here we review the origin of the quasispecies concept and some biological implications of quasispecies dynamics. Two main aspects are addressed: (i) mutant clouds as reservoirs of phenotypic variants for virus adaptability and (ii) the internal interactions that are established within mutant spectra that render a virus ensemble the unit of selection. The understanding of viruses as quasispecies has led to new antiviral designs, such as lethal mutagenesis, whose aim is to drive viruses toward low fitness values with limited chances of fitness recovery. The impact of quasispecies for three salient human pathogens, human immunodeficiency virus and the hepatitis B and C viruses, is reviewed, with emphasis on antiviral treatment strategies. Finally, extensions of quasispecies to nonviral systems are briefly mentioned to emphasize the broad applicability of quasispecies theory.