Treatment predictors of a sustained virologic response in hepatitis B and C

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J Hepatol. 2008 Jul 31. [Epub ahead of print]

Treatment predictors of a sustained virologic response in hepatitis B and C.

Kau A, Vermehren J, Sarrazin C.

Zentrum der Inneren Medizin, Medizinische Klinik 1, Klinikum der J. W.

Goethe-Universität, Theodor-Stern-Kai 7, 60590 furt am Main, Germany.

Treatment predictors are important tools for the management of therapy in

patients with chronic hepatitis B and C virus (HBV, HCV) infection. In chronic

hepatitis B, several pretreatment parameters have been identified for prediction

of virologic response to interferon alfa-based antiviral therapies or treatment

with polymerase inhibitors. In interferon alfa and pegylated interferon

alfa-treated patients, low baseline HBV DNA concentrations, HBV genotype A (,

and high baseline ALT levels are significantly associated with treatment

response. In patients treated with nucleos(t)ide analogues, low baseline HBV DNA

but not viral genotype is positively associated with virologic response. During

treatment the best predictor of response is HBV DNA kinetics. Early viral

suppression is associated with favourable virologic response and reduced risk

for subsequent resistance mutations. For the current standard treatment with

pegylated interferon alfa and ribavirin in patients with chronic hepatitis C,

infection with HCV genotypes 2 and 3, baseline viral load below

400,000-800,000IU/ml, Asian and Caucasian ethnicity, younger age, low GGT

levels, absence of advanced fibrosis/cirrhosis, and absence of steatosis in the

liver have been identified as independent pretreatment predictors of a sustained

virologic response. After initiation of treatment, initial viral decline with

undetectable HCV-RNA at week 4 of therapy (RVR) is the best predictor of

sustained virologic response independent of HCV genotype.

PMID: 18715665 [PubMed - as supplied by publisher