Page 19 - The Flying Publisher Guide to Hepatitis C Treatment

Antiviral Therapy: The Basics
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Age. Younger patients (<40 years) have higher SVR rates with
SoC. Nonresponders tend to be on average 5 years older than
sustained responders (Hadziyannis 2004). Therapy is generally
deferred in elderly patients with comorbid conditions since
these may be exacerbated by combination therapy with
PegIFN/RBV. Despite all these observations, age alone should not
preclude antiviral therapy, and treatment decisions should be
made on a case by case basis.
The efficacy and safety of the PegIFN/RBVcombination is also
evaluated for pediatric patients. Only a limited number of
children with HCV infection cleared viremia spontaneously over
a decade of follow-up, and those who did were more likely to be
infected with G3. Persistent viral replication led to end-stage
liver disease in a small subgroup characterized by perinatal
exposure, maternal drug use, and infection with HCV G1a.
Children with such features should be considered for early
treatment. After treating children, SVR was attained in 65% of
the cases, genotype being the main predictor of response (G1:
53%; G2/3: 93%; G4: 80%). The rate of SVR was similar in younger
and older children. Baseline VL was the main predictor of
response in the G1 cohort. AEs were generally mild or moderate
in severity (Wirth 2010).
Race. Racial differences in the response to PegIFN/RBV therapy
have been signaled, with Hispanics and African-Americans less
likely to respond compared to Whites or Taiwanese patients
(Ghany 2009).
Co-morbidities
Obesity and its histological correlate, steatosis, are common
determinants of liver disease progression in HCV infection. We
must keep in mind that “not all hepatic fat is alike” and that the
etiology of steatosis makes an important difference in the
progression of hepatic fibrosis, the development of HCC,
extrahepatic manifestations, and prognosis.
Patients with BMI>30 kg/m2 are more likely to be insulin-
resistant, to have more advanced hepatic steatosis or fibrosis