Comparison of the sensitivity of nested PCR in the 5' non-coding and the NS5 regions of the HCV genome

[Hepatitis C: the recovery]

After the discovery of the hepatitis B virus in 1968 and of the hepatitis A virus in 1973, many years were needed to identify the hepatitis C virus (HCV) in 1989. The discovery of HCV was a revolution for hepatology because of the magnitude of the global burden related to HCV infection, a major cause of cirrhosis and hepatocellular carcinoma. Therapy of hepatitis C has rapidly evolved with currently nearly 60% of sustained virological response with the combination of pegylated interferon plus ribavirin. In patients with sustained virological response, viral eradication, corresponding to the cure of infection, and regression of histological liver lesions have been demonstrated. Recently, the availability of in vitro culture systems allowed to characterize viral enzymes, potential therapeutic targets. A novel therapeutic era is open with the protease and polymerase inhibitors, used as a first step in association with pegylated interferon and ribavirin, both to increase efficacy and decrease the risk of resistance. Thanks to these new molecules with a potent antiviral activity, one can reasonably predict a rapid improvement of treatments becoming more efficient and also better tolerated with the progressive replacement of interferon and ribavirin by combinations of these virus specific enzyme inhibitors.

Genomic and phylogenetic analysis of hepatitis C virus isolates from argentine patients: a six-year retrospective study

Typing of hepatitis C virus (HCV) isolates from Argentine patients was performed by using different methodologies in a population of 243 patients. HCV subtype was assigned based upon restriction fragment length polymorphism (RFLP). HCV RNA genomes obtained from serum samples were classified as belonging to clade 1 (53.5%), 2 (23. 0%), or 3 (8.6%); 14.8% of samples showed HCV mixed infections, more frequently implying different subtypes within the same clade. In addition to RFLP typing, phylogenetic relatedness among sequences from both 5' untranslated region (n = 50) and nonstructural 5B coding region (n = 15) was established.

Lack of benefit of escalating dosage of interferon alfa in patients with chronic hepatitis C

BACKGROUND & AIMS

In patients with chronic hepatitis C treated with interferon alfa, sustained normalization of alanine aminotransferase was observed in about 20%, and no predictive factor of response could be clearly identified. The aims of this study were to assess the efficacy of an escalating dose of interferon and to determine the predictive factors of response.

METHODS

Seventy-five patients were randomly assigned to two groups. Twenty-five patients received a dosage of 3 million units of recombinant interferon alfa-2b three times weekly for 24 weeks, and 50 patients received a dose that was increased to 5 million units at 8 weeks in nonresponders and to 10 million units 8 weeks later in persistent nonresponders. Multivariate analysis was performed to determine the features associated with response.

RESULTS

A sustained response was observed in 17% of the patients with constant dosage and in 19% of patients with an escalating dosage. Low pretreatment serum hepatitis C virus RNA levels and hepatitis C virus genotype were found to be independent predictive factors of sustained response.

CONCLUSIONS

In patients with chronic hepatitis C, an escalating dosage of interferon did not improve the overall rate of response. Low pretreatment serum hepatitis C virus RNA levels and genotype other than 1b were the only predictive factors of sustained response.