Page 25 - The Flying Publisher Guide to Hepatitis C Treatment

Antiviral Therapy: The Basics
| 25
– rapid virological response (RVR): undetectable HCV RNA
at week 4 (measured by real-time PCR assay with lower limit
of detection <15 IU/mL)
– early virological response (EVR), assessed at week 12
– complete EVR (cEVR): undetectable HCV RNA at week 12
– partial EVR (pEVR): decrease of HCV RNA by >2 log 10 (100
fold) from baseline values at week 12
– end-of-treatment virological response (EoTR):
undetectable HCV RNA at the end of therapy (week 24 for
genotypes 2/3 or week 48 for genotypes 1/4)
– sustained virologic response (SVR): undetectable HCV
RNA 6 months after completing therapy
The standard recommended duration of treatment (Table 1.2) is
48 weeks for HCV genotypes 1/4 (with SVR rates of about 50%
and 65%, respectively) and 24 week for genotypes 2/3 (with
SVR rates of more than 75%). There is so far insufficient
experience to provide recommendations for HCV genotypes 5/6.
High weight-based dose RBV (15 mg/kg body) is recommended
for patients with baseline factors suggesting low responsiveness
(IR, metabolic syndrome, severe fibrosis or cirrhosis, older age).
The most important marker of treatment success is SVR. An
EoTR does not accurately predict a SVR, but is necessary for it to
occur. A RVR is the best predictor of SVR, if patients fulfill the
complete duration of treatment. The absence of an EVR is highly
predictive of treatment failure.
Treatment should be stopped at
– week 12 if the HCV RNA decrease is less than 2 log 10 IU/ml,
compared with the baseline value (the SVR rate in these
patients is less than 2%)
– week 24 in patients with detectable HCV RNA (>50 IU/ml),
due to a minimal chance of SVR (1–3%)