Page 50 - The Flying Publisher Guide to Hepatitis C Treatment

50 | Hepatitis C Treatment

may wait for triple therapy while patients with advanced
fibrosis should be treated immediately with available
regimens;
– Virological response during the initial course of therapy.
Null and partial responders achieve lower SVR rates as
compared with relapsers, irrespective of therapeutic
regimen. Slow virological responders who have relapsed
may benefit from extending duration of therapy;
– Previous dose regimen and adherence assessment.
Optimizing RBV dosing, minimizing dose reductions by use
of growth factors and avoiding premature discontinuations
are important issues during retreatment;
– Correctable factors that may affect the subsequent
response to therapy: steatosis, insulin-resistance, chronic
alcohol consumption etc.

How to manage genotype 2 and 3 non-responders
and relapsers ?
Nonresponders/relapsers infected with HCV G2/3
Genotype 2 or 3 infected patients are easier to treat and require
only 24 weeks of therapy with PegIFN and low-dose of RBV (800
mg/day) (Zeuzem 2004). Patients who are intolerant of a planned
24-week course of therapy can discontinue the antiviral therapy
between weeks 12 and 16 without a negative impact on SVR, if
they have achieved a RVR (Mangia 2005).
Treatment failure is uncommon in genotype 2 and 3 patients.
Primary non-response to PegIFN/RBV is a very rare event, while
partial response or virological relapse after therapy withdrawal
may be detected in a subgroup of patients. Factors that have
been associated with suboptimal response to SoC in HCV
genotypes 2/3 patients include hepatic steatosis, obesity and IR
(Zeuzem 2004, Poustchi 2008), advanced fibrosis (Dalgard 2004)
and high pretreatment viremia (Shiffman 2007).
In most clinical trials, SVR rates in patients with HCV genotype 2
or 3 chronic infection, considered as a single group, exceed 80%