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Jessner W, Gschwantler M, Formann E, Gurguta C, Watkins-Riedel T, Wrba F, Ferenci P. Very Early Viral Kinetics on Interferon Treatment in Chronic Hepatitis C virus Genotype 4 Infection. Antivir Ther 2008. [DOI: 10.1177/135965350801300411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Interferon (IFN)-resistant hepatitis C virus strains limit efficacy of antiviral combination therapy in patients infected with genotypes 1 and 4. A single test dose of IFN was useful to identify non-responders to IFN-α2b/ribavirin (RBV) or likely non-responders to pegylated (PEG)-IFN-α2a/RBV therapy in genotype 1 patients. Our aim was to investigate this approach in genotype 4 patients. Methods Viral load was measured in 46 patients before and 24 h after 10 megaunits (MU) IFN-α2b, and before and during 2 weeks of daily 5 MU IFN-α2b administration. Thereafter, patients received 48 weeks combination therapy with either 180 μg PEG-IFN-α2a/week ( n=33), 1.5 μg/kg PEG-IFN-α2b/week ( n=7) or 5 MU IFN-α2b/2 days ( n=6), along with 1–1.2g RBV/day. For prediction analysis the largest group (PEG-IFN-α2a) was evaluated only. Results Median 24 h log10 change after 10 MU IFN-α2b was 1.15 (range 0.08–2.48) and after 5 MU IFN-α2b was 0.81 (-0.12–2.22; P<0.0001). Log10 changes after 2 weeks on 5 MU IFN-α2b daily and 24 h after 10 MU were the best predictors of early virological response (defined by negativity of a standard qualitative PCR) to PEG-IFN-α2a/RBV combination therapy (area under curve [AUC]=0.97; P<0.001, receiver operating characteristics), 24 h log10 change after 10 MU was the best predictor of sustained virological response (SVR; AUC=0.91, P=0.001). Conclusion As in genotype 1 patients, there is large variation in IFN responsiveness, including the presence of resistant strains, in genotype 4 patients. A 24 h log10 change after 10 MU IFN-α2b is an excellent predictor of SVR on PEG-IFNα2a/RBV combination therapy. This test may be useful to obtain homogeneous groups for clinical studies and could help in clinical decision making.
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Affiliation(s)
- Wolfgang Jessner
- Department of Internal Medicine III, Gastroenterology and Hepatology, Vienna Medical University, Vienna, Austria
- Department of Internal Medicine, Gastroenterology and Hepatology, Innsbruck Medical University, Innsbruck, Austria
| | - Michael Gschwantler
- Department of Internal Medicine IV, KA Rudolfstiftung, Vienna, Austria
- Present affiliation: Department of Medicine IV, Wilhelminenspital-Hospital of Vienna, Vienna, Austria
| | - Elisabeth Formann
- Department of Internal Medicine III, Gastroenterology and Hepatology, Vienna Medical University, Vienna, Austria
- Present affiliation: Department of Medicine IV, Wilhelminenspital-Hospital of Vienna, Vienna, Austria
| | - Calin Gurguta
- Department of Internal Medicine III, Gastroenterology and Hepatology, Vienna Medical University, Vienna, Austria
- Present affiliation: Department of Medicine I, Hospital Hietzing, Vienna, Austria
| | - Thomas Watkins-Riedel
- Department of Clinical Virology, Medical University of Vienna, Austria
- Present affiliation: Department of Hygiene, Wilhelminenspital-Hospital of Vienna, Vienna, Austria
| | - Friedrich Wrba
- Department of Clinical Pathology, Medical University of Vienna, Austria
| | - Peter Ferenci
- Department of Internal Medicine III, Gastroenterology and Hepatology, Vienna Medical University, Vienna, Austria
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Jessner W, Watkins-Riedel T, Formann E, Steindl-Munda P, Ferenci P. Hepatitis C viral dynamics: basic concept and clinical significance. J Clin Virol 2002; 25 Suppl 3:S31-9. [PMID: 12467775 DOI: 10.1016/s1386-6532(02)00194-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Viral dynamics is a concept analyzing the time course of treatment-induced changes in blood virion concentration (kinetics) to derive conclusions of where, when and how in the living organism virions are produced or eliminated. Originally applied to human immunodeficiency virus type 1 and hepatitis B virus, it has elucidated mechanisms of antiviral therapy in hepatitis C virus infection as well. This review summarizes key aspects of mathematical modeling as well as important clinical applications, namely induction therapy and prediction of virologic response to treatment. Furthermore, limitations of currently available quantitative assays will be discussed.
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Affiliation(s)
- Wolfgang Jessner
- Department of Internal Medicine IV, Gastroenterology and Hepatology, University Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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