Page 57 - The Flying Publisher Guide to Hepatitis C Treatment

Antiviral therapy in non-responders, relapsers and special populations | 57

Outlook
A large proportion of patients with genotype 1 CHC will not
respond to standard of care treatment (SoC). Patients with
treatment failure to PegIFN can be classified into null
responders, partial responders, patients with breakthrough and
relapsers. Multiple fixed and correctable factors identified
during the previous course of treatment must be considered
when counseling about retreatment. The kinetic in HCV RNA
during a prior course of therapy has important implications for
the likelihood of response to retreatment. Triple combination
regimens including a protease inhibitor, such as telaprevir or
boceprevir, proved to be a good option for prior non-sustained
responders.
Treatment failure is uncommon in patients with genotypes 2/3
HCV infection. Retreatment in these patients should be
considered, as response rates are reasonable, particularly with
prolonged duration of therapy.
There is an increased prevalence of HCV infection among special
populations (IDUs, comorbidities, HIV-infected patients, African
Americans) and their management requires special
consideration.

Links
– International clinical trials registry platform:
http://www.who.int/ictrp/en
– US clinical trials registry: http://clinicaltrials.gov
– Cochrane Database of Systematic Reviews
– http://www2.cochrane.org/reviews
– HCV Drug Dose and Response Decision Support Tool –
Clinical Care Options
http://www.clinicaloptions.com/Hepatitis/Management
– Nature Reviews Gastroenterology & Hepatology
http://www.nature.com/nrgastro/journal/v8/n5/index