Page 20 - The Flying Publisher Guide to Hepatitis C Treatment

20 | Hepatitis C Treatment

and to experience a reduced response to combination therapy
(Khattab 2010).
Insulin resistance (IR) is one of the strongest negative
predictors of response to HCV therapy. Improved insulin
sensitivity may be associated with better treatment response and
even with HCV clearance. It is important to control diabetes
before starting PegIFN/RBV therapy, because IFN induces a
decrease in glucose uptake by peripheral tissue and the liver.
New HCV protease inhibitors can restore insulin sensitivity in
patients chronically infected with G1 HCV. HCV G3 has a direct
steatogenic effect independent of IR.
Co-infections. Patients with human immunodeficiency virus-
HIV-HCV coinfection have been shown to respond less
favorably to antiviral therapy than patients infected with HCV
alone. Moreover, serious AEs were far more frequent (35%) than
have been reported among HIV-seronegative patients (10-15%).
However, co-infected patients have a rapid fibrosis progression
rate and experience complications of portal hypertension and
PegIFN/RBV should be initiated, if treatment response outweigh
the risks of complications from the AEs of therapy (see chapter 3
for details).
Dual infections of HCV and hepatitis B virus (HBV) occur in
up to 5% of the general population in HCV-endemic areas and
lead to more severe liver disease. Recently, a large, open-label,
comparative multicenter study confirmed the efficacy of
PegIFN/RBV for patients with chronic HCV-HBV dual infection
in Taiwan (Jamma 2010).

Treatment related factors
The key components of therapy that affect the success rate are:
the optimal duration of therapy (48 or 24 weeks depending on
the viral genotype), the need for different regimens for patients
with G1/4 versus G2/3 infections, the appropriate doses of both
PegIFN and RBV and the effective management of the treatment-
associated side effects (Ferenci 2008).